Provider Demographics
NPI:1003002320
Name:EKLUND, D. JASON (DMD PA)
Entity Type:Individual
Prefix:
First Name:D.
Middle Name:JASON
Last Name:EKLUND
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 OLD BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4702
Mailing Address - Country:US
Mailing Address - Phone:601-939-3561
Mailing Address - Fax:601-939-3583
Practice Address - Street 1:2701 OLD BRANDON RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4702
Practice Address - Country:US
Practice Address - Phone:601-939-3561
Practice Address - Fax:601-939-3583
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2671921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice