Organization
MICHAEL Q EDWARDS DMD PC
Active
Other names
Optima Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL Q EDWARDS DMD (OWNER CEO)
(636) 583-2612
Entity
Organization
Contact information
Practice address
124 WEST MAIN STREET, UNION, MO 63084
(636) 583-2612
(636) 583-6479
Mailing address
124 WEST MAIN STREET, UNION, MO 63084
(636) 583-2612
(636) 583-6479
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE015747
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015747
DELTA DENTAL PLAN
MO
Enumeration date
10/25/2006
Last updated
08/22/2020
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