Individual
DR. JESSE IVEY EDWARDS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1 WAHOO AVE, GROTON, CT 06349-2324
(860) 694-3047
Mailing address
1647 ADMIRAL TAUSSIG BLVD, NORFOLK, VA 23511-2803
(757) 953-8604
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401418304
VA
122300000X
Dentist
13704
CT
122300000X
Dentist
2901021535
MI
1223G0001X
General Practice Dentistry
Primary
0401418304
VA
1223G0001X
General Practice Dentistry
13704
CT
1223G0001X
General Practice Dentistry
2901021535
MI
Other
Enumeration date
07/04/2015
Last updated
04/14/2026
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