MEDICARE: JULIA LEE EDGE

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	124Q00000X	Dental Hygienist	2020023985	MO

General Provider Information

NPI Number	:	1568313286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA LEE EDGE

Provider Business Mailing Address
First Line	:	12958 HIGHWAY U
Second Line	:
City	:	ODESSA
State	:	MO
Zip	:	64076-6277
Country	:	US
Telephone Number	:	816-730-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 NW MOCK AVE STE A
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-3106
Country	:	US
Telephone Number	:	816-730-1199
Fax Number	:

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

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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Directions to “ JULIA LEE EDGE ” Practice Location

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