Individual
KENNETH EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1205 NE CORONADO DR, BLUE SPRINGS, MO 64014-2928
(816) 228-4090
Mailing address
2622 S 13TH ST, FRNT, SAINT LOUIS, MO 63118-1804
(314) 309-4494
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2016006251
MO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2016006251
MO
Other
Enumeration date
08/10/2016
Last updated
03/17/2018
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