Provider Demographics
NPI:1023279866
Name:EDGAR, JOHN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:EDGAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 LANDOVER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-7513
Mailing Address - Country:US
Mailing Address - Phone:847-550-5000
Mailing Address - Fax:847-550-5081
Practice Address - Street 1:60 LANDOVER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-7513
Practice Address - Country:US
Practice Address - Phone:847-550-5000
Practice Address - Fax:847-550-5081
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A16412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist