Provider Demographics
NPI:1114034188
Name:AUGUSTINE, JASON JAMES (DDS MS PC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JAMES
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:DDS MS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 W BELL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2748
Mailing Address - Country:US
Mailing Address - Phone:602-978-6910
Mailing Address - Fax:602-978-6920
Practice Address - Street 1:4025 W BELL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2748
Practice Address - Country:US
Practice Address - Phone:602-978-6910
Practice Address - Fax:602-978-6910
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist