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General NPI Number Information
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NPI Number | 1396127585
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Entity Type | Organization
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Legal Business Name | JON E EDMONDSON D.D.S., P.A.
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 3100 LORD BALTIMORE DR SUITE 210
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City | BALTIMORE
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State | MD
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Zip | 21244-2879
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Country | US
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Telephone | 410-944-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 LORD BALTIMORE DR SUITE 210
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City | BALTIMORE
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State | MD
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Zip | 21244-2879
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Country | US
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Telephone | 410-944-9090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON ERWYNN EDMONDSON
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Credential | D.D.S.
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Telephone | 410-944-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11146
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License Number State | MD
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