Individual
JEREMY ALAN EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1004 MEDICAL PARK BLVD, EDMOND, OK 73013-3025
(405) 348-8184
(405) 348-5349
Mailing address
1004 MEDICAL PARK BLVD, EDMOND, OK 73013-3025
(405) 348-8184
(405) 348-5349
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6586
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/18/2014
Last updated
06/17/2022
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