Individual
DR. CHARLY NICOLE EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6001
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6001
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10762
TN
122300000X
Dentist
Primary
4295-22
MS
1223G0001X
General Practice Dentistry
10762
TN
Other
Enumeration date
06/02/2018
Last updated
06/13/2022
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