Healthcare Provider Details

I. General information

NPI: 1790835924
Provider Name (Legal Business Name): JANE ELIZABETH EDGAR D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 S MAIN ST
YARDLEY PA
19067-1510
US

IV. Provider business mailing address

37 S MAIN ST
YARDLEY PA
19067-1510
US

V. Phone/Fax

Practice location:
  • Phone: 215-493-5347
  • Fax: 215-493-1176
Mailing address:
  • Phone: 215-493-5347
  • Fax: 215-493-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number029215L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: