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NPI Code Detail

MEDICARE: DR. JAMES ANTHONY EDMONDSON D.D.S.

MEDICARE: DR. JAMES ANTHONY EDMONDSON D.D.S.
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
11223G0001XGeneral Practice Dentistry09435TX

General Provider Information

NPI Number : 1013094606
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES ANTHONY EDMONDSON D.D.S.
Provider Business Mailing Address
First Line : 2415 S AUSTIN AVE
Second Line : STE. 101
City : DENISON
State : TX
Zip : 75020-7741
Country : US
Telephone Number : 903-327-8540
Fax Number : 903-327-8749
Provider Business Practice Location Address
First Line : 2415 S AUSTIN AVE
Second Line : STE. 101
City : DENISON
State : TX
Zip : 75020-7741
Country : US
Telephone Number : 903-327-8540
Fax Number : 903-327-8749
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 11/20/2012

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