Individual
KEVIN RAY EDWARDS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS LLC
Contact information
Practice address
833 SW 11TH AVE, SUITE 910, PORTLAND, OR 97205-2125
(503) 222-5580
(503) 224-4079
Mailing address
833 SW 11TH AVE, SUITE 910, PORTLAND, OR 97205-2125
(503) 222-5580
(503) 224-4079
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
07877
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326008
UNITED CONCORDIA
—
Enumeration date
07/19/2005
Last updated
07/21/2022
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