Provider Demographics
NPI:1033590534
Name:ALLRED, JASON (DMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ALLRED
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 N THORNTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6049
Mailing Address - Country:US
Mailing Address - Phone:208-777-8668
Mailing Address - Fax:
Practice Address - Street 1:737 N THORNTON ST STE A
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6049
Practice Address - Country:US
Practice Address - Phone:208-777-8668
Practice Address - Fax:208-457-8112
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD52061223G0001X
GADN0149601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice