Individual
JONATHAN EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945
Mailing address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2011017532
MO
Other
Enumeration date
06/17/2011
Last updated
06/17/2011
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