Provider Demographics
NPI:1093956401
Name:STUAN, JASON T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:STUAN
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 1:889 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6275
Mailing Address - Country:US
Mailing Address - Phone:707-822-0525
Mailing Address - Fax:707-822-0500
Practice Address - Street 1:889 9TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6275
Practice Address - Country:US
Practice Address - Phone:707-822-0525
Practice Address - Fax:707-822-0500
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48681122300000X
CACA48681122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist