Individual
DEKOVEN M EDWARDS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10704 GREYSTONE AVE, OKLAHOMA CITY, OK 73120-3216
(405) 201-2171
Mailing address
10704 GREYSTONE AVE, OKLAHOMA CITY, OK 73120-3216
(405) 201-2171
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
10/30/2012
Last updated
11/06/2012
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