Provider Demographics
NPI:1083693535
Name:JUAREZ, JASON J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:J
Last Name:JUAREZ
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 1:1075 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2431
Mailing Address - Country:US
Mailing Address - Phone:419-782-1126
Mailing Address - Fax:419-782-8790
Practice Address - Street 1:1075 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2431
Practice Address - Country:US
Practice Address - Phone:419-782-1126
Practice Address - Fax:419-782-8790
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2263607Medicaid
OHJU40343519Medicare ID - Type Unspecified