Provider Demographics
NPI:1619156858
Name:EDWARDS, JASON ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ANTHONY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:449 S 12TH ST
Mailing Address - Street 2:APT 1201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5606
Mailing Address - Country:US
Mailing Address - Phone:813-528-8999
Mailing Address - Fax:813-528-8997
Practice Address - Street 1:5420 LAND O LAKES BLVD
Practice Address - Street 2:SUITE #104
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-3401
Practice Address - Country:US
Practice Address - Phone:813-528-8999
Practice Address - Fax:813-528-8997
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN167091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery