Provider Demographics
NPI:1083049696
Name:CARLYON, JASON THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:CARLYON
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 1:8118 SHOAL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8041
Mailing Address - Country:US
Mailing Address - Phone:512-452-8262
Mailing Address - Fax:512-420-8265
Practice Address - Street 1:8118 SHOAL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8041
Practice Address - Country:US
Practice Address - Phone:512-452-8262
Practice Address - Fax:512-420-8265
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist