Provider Demographics
NPI:1073575197
Name:EDMONDS, JAMES NORMAN JR (DMD MPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NORMAN
Last Name:EDMONDS
Suffix:JR
Gender:M
Credentials:DMD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 FREEPORT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238
Mailing Address - Country:US
Mailing Address - Phone:412-967-9200
Mailing Address - Fax:412-967-1172
Practice Address - Street 1:1326 FREEPORT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238
Practice Address - Country:US
Practice Address - Phone:412-967-9200
Practice Address - Fax:412-967-1172
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020021L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T29753Medicare UPIN
158111Medicare ID - Type Unspecified