Active NPI
Jonathan Edwards, DDS
- Dentist
- Cape Girardeau, MO
National Provider Identifier
1497040497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2011017532
- Practice address
- 408 S Broadview St
Cape Girardeau, MO 63703-5725 - Phone
- (573) 332-0808
- Fax
- (573) 339-7945
- NPI assigned
- Jun 17, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2011017532 | MO | Primary |
Addresses
Primary practice location
408 S Broadview St
Cape Girardeau, MO 63703-5725
Mailing address
408 S Broadview St
Cape Girardeau, MO 63703-5725
Phone (573) 332-0808
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 1, 2016 through Feb 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011017532 | MO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308268800000",
"number": "1497040497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 S BROADVIEW ST",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637035725",
"telephone_number": "573-332-0808",
"fax_number": "573-339-7945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 S BROADVIEW ST",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637035725",
"telephone_number": "573-332-0808",
"fax_number": "573-339-7945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "JONATHAN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-17",
"last_updated": "2011-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2011017532",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cape Girardeau, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.