Provider Demographics
NPI:1942815139
Name:JESSE EDWARDS DMD PLLC
Entity Type:Organization
Organization Name:JESSE EDWARDS DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-415-8600
Mailing Address - Street 1:2815 CORRINE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-2235
Mailing Address - Country:US
Mailing Address - Phone:407-894-5061
Mailing Address - Fax:407-897-0887
Practice Address - Street 1:2815 CORRINE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-2235
Practice Address - Country:US
Practice Address - Phone:407-894-5061
Practice Address - Fax:407-897-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental