Individual
DR. MARION JACKSON EDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY, 501 S. PRESTON ST., LOUISVILLE, KY 40292-0001
(502) 852-5128
(502) 852-7163
Mailing address
UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY, 501 S. PRESTON ST., LOUISVILLE, KY 40292-0001
(502) 852-5128
(502) 852-7163
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
3956
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9181733
DORAL
KY
Enumeration date
09/01/2006
Last updated
07/08/2007
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