MEDICARE: DR. JASON ANTHONY EDWARDS DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN16709	FL

General Provider Information

NPI Number	:	1619156858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON ANTHONY EDWARDS DMD

Provider Business Mailing Address
First Line	:	449 S 12TH ST
Second Line	:	APT 1201
City	:	TAMPA
State	:	FL
Zip	:	33602-5606
Country	:	US
Telephone Number	:	813-528-8999
Fax Number	:	813-528-8997

Provider Business Practice Location Address
First Line	:	5420 LAND O LAKES BLVD
Second Line	:	SUITE #104
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-3401
Country	:	US
Telephone Number	:	813-528-8999
Fax Number	:	813-528-8997

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

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/24/2016

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