Provider Demographics
NPI:1366767121
Name:EDWARDS & CAVENDISH P.A.
Entity type:Organization
Organization Name:EDWARDS & CAVENDISH P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-353-3303
Mailing Address - Street 1:137 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3801
Mailing Address - Country:US
Mailing Address - Phone:904-353-3303
Mailing Address - Fax:904-353-3634
Practice Address - Street 1:137 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3801
Practice Address - Country:US
Practice Address - Phone:904-353-3303
Practice Address - Fax:904-353-3634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty