Individual
DR. DANIEL SHANE EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
103 N BRENTWOOD STE 400, LUFKIN, TX 75904-7147
(366) 394-8679
(936) 639-4868
Mailing address
42 HARLAN RD, POTTSBORO, TX 75076-4101
(214) 632-4600
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18117
TX
1223G0001X
General Practice Dentistry
18117
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
752851171
TAX ID
TX
Enumeration date
05/29/2007
Last updated
09/15/2022
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