Provider Demographics
NPI:1063826063
Name:ESPINOZA, JASON LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEE
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 TEXAS AVE S
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-3917
Mailing Address - Country:US
Mailing Address - Phone:979-693-5130
Mailing Address - Fax:
Practice Address - Street 1:2101 TEXAS AVE S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-3917
Practice Address - Country:US
Practice Address - Phone:979-693-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice