Provider Demographics
NPI:1114148889
Name:JASON D. NEDZINSKI, D.M.D., P.C.
Entity Type:Organization
Organization Name:JASON D. NEDZINSKI, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NEDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-781-1212
Mailing Address - Street 1:1082 S MICHAEL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3003
Mailing Address - Country:US
Mailing Address - Phone:814-781-1212
Mailing Address - Fax:
Practice Address - Street 1:1082 S MICHAEL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3003
Practice Address - Country:US
Practice Address - Phone:814-781-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty