# LAND O LAKES ORAL MAXILLOFACIAL & IMPLANT SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235471590
- **Authorized official:** DR. JASON EDWARDS D.M.D. (PRESIDENT)
- **Authorized official phone:** (813) 528-8999

## Contact information

- **Practice address:** 5420 LAND O LAKES BLVD, SUITE \#103, LAND O LAKES, FL 34639-3401
- **Practice address phone:** (813) 528-8999
- **Practice address fax:** (813) 528-8997
- **Mailing address:** 5420 LAND O LAKES BLVD, SUITE \#103, LAND O LAKES, FL 34639-3401
- **Mailing address phone:** (813) 528-8999
- **Mailing address fax:** (813) 528-8997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DN16709 | FL | Yes |

## Other

- **Enumeration date:** 03/25/2013
- **Last updated:** 03/25/2013