Individual
DR. R BLAKE EDMONDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1501 E WADSWORTH AVE, PHILADELPHIA, PA 19150-1615
(215) 247-1040
(215) 247-1647
Mailing address
1501 E WADSWORTH AVE, PHILADELPHIA, PA 19150-1615
(215) 247-1040
(215) 247-1647
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS19126L
PA
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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