Provider Demographics
NPI:1477656064
Name:EDWARDS, CHARLES M JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 N EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254
Mailing Address - Country:US
Mailing Address - Phone:904-388-9038
Mailing Address - Fax:904-388-9473
Practice Address - Street 1:774 N EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254
Practice Address - Country:US
Practice Address - Phone:904-388-9038
Practice Address - Fax:904-388-9473
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist