NPIMap

Organization Active NPI

Charles M Edwards Jr DMD PA

  • Dentist
  • Jacksonville, FL
National Provider Identifier
1023111614
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6342 Issued in FL
Legal business name
CHARLES M EDWARDS JR DMD PA
Practice address
774 N Edgewood Ave
Jacksonville, FL 32254
Phone
(904) 388-9038
Fax
(904) 388-9473
NPI assigned
Sep 7, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles M Edwards Jr., DMDNPI 1477656064
Title
Owner
Phone
(904) 388-9038

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6342 FL Primary

Addresses

Primary practice location

774 N Edgewood Ave
Jacksonville, FL 32254

Mailing address

774 N Edgewood Ave
Jacksonville, FL 32254
Phone (904) 388-9038

National Provider Directory

National Provider Directory
Tax ID family
Charles M Edwards Jr DMD PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

774 Edgewood Ave N
Jacksonville, FL 32254
Phone (904) 388-9038

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023111614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "774 N EDGEWOOD AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32254",
            "telephone_number": "904-388-9038",
            "fax_number": "904-388-9473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 N EDGEWOOD AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32254",
            "telephone_number": "904-388-9038",
            "fax_number": "904-388-9473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES M EDWARDS JR DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-388-9038",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "6342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.