MEDICARE: ERIN KELSEY EDMONDSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	31523	TX
2	1223P0300X	Periodontics	31523	TX

General Provider Information

NPI Number	:	1952776494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN KELSEY EDMONDSON DDS

Provider Business Mailing Address
First Line	:	6609 BLANCO RD STE 125
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-6177
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6609 BLANCO RD STE 125
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-6177
Country	:	US
Telephone Number	:	713-480-1877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	04/19/2024

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