Provider Demographics
NPI:1083225924
Name:FRANKLIN J. EDGE D.M.D., PC
Entity Type:Organization
Organization Name:FRANKLIN J. EDGE D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (DENTIST)
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:EDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-477-3393
Mailing Address - Street 1:1311 KIMBER LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9149
Mailing Address - Country:US
Mailing Address - Phone:812-477-3393
Mailing Address - Fax:812-479-4120
Practice Address - Street 1:1311 KIMBER LN
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9149
Practice Address - Country:US
Practice Address - Phone:812-477-3393
Practice Address - Fax:812-479-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1558343160Medicaid