Basic Information
| Provider Information | |||||||||
| NPI: | 1952313892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | PETER | ||||||||
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| Credential: | MD, DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481081633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346475299 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 EAST MEDICAL CENTER DR | ||||||||
| Address2: | MED INN ROOM C233A | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347635963 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 01/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 4301082697 | MI | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 208600000X | 4301082697 | MI | Y | Allopathic & Osteopathic Physicians | Surgery | 122300000X | 4301082697 | MI | N | Dental Providers | Dentist |
No ID Information.