Provider Demographics
NPI:1043407588
Name:JASON, BARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:JASON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BARRY
Other - Middle Name:
Other - Last Name:JASON DDS P.C.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1 BARSTOW RD
Mailing Address - Street 2:SUITE P-18
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3501
Mailing Address - Country:US
Mailing Address - Phone:516-767-0900
Mailing Address - Fax:516-767-3285
Practice Address - Street 1:1 BARSTOW RD
Practice Address - Street 2:SUITE P-18
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3501
Practice Address - Country:US
Practice Address - Phone:516-767-0900
Practice Address - Fax:516-767-3285
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice