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NPI Code Detail

MEDICARE: JESSE EDWARDS DMD PLLC

MEDICARE: JESSE EDWARDS DMD PLLC
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1942815139
Entity Type Code : Organization
Provider Name (Legal Business Name) : JESSE EDWARDS DMD PLLC
Provider Business Mailing Address
First Line : 2815 CORRINE DR
Second Line :
City : ORLANDO
State : FL
Zip : 32803-2235
Country : US
Telephone Number : 407-894-5061
Fax Number : 407-897-0887
Provider Business Practice Location Address
First Line : 2815 CORRINE DR
Second Line :
City : ORLANDO
State : FL
Zip : 32803-2235
Country : US
Telephone Number : 407-894-5061
Fax Number : 407-897-0887
Authorized Official
Title or Position : MANAGER
Name : DR. JESSE EDWARDS
Credential : DMD
Telephone Number : 407-415-8600
Provider Enumeration Date : 09/14/2020
Last Update Date : 09/14/2020

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