Provider Demographics
NPI:1720216880
Name:EDWARDS, EUNJUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUNJUNG
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4254
Mailing Address - Country:US
Mailing Address - Phone:901-323-8488
Mailing Address - Fax:901-323-8489
Practice Address - Street 1:845 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4254
Practice Address - Country:US
Practice Address - Phone:901-323-8488
Practice Address - Fax:901-323-8489
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9009122300000X
TX25093122300000X
AR3749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist