Healthcare Provider Details

I. General information

NPI: 1073575197
Provider Name (Legal Business Name): JAMES NORMAN EDMONDS JR. DMD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 FREEPORT RD SUITE 300
PITTSBURGH PA
15238
US

IV. Provider business mailing address

1326 FREEPORT RD SUITE 300
PITTSBURGH PA
15238
US

V. Phone/Fax

Practice location:
  • Phone: 412-967-9200
  • Fax: 412-967-1172
Mailing address:
  • Phone: 412-967-9200
  • Fax: 412-967-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS020021L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: