Provider Demographics
NPI:1154096295
Name:JASON D. MAH DMD PLLC
Entity Type:Organization
Organization Name:JASON D. MAH DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-750-1385
Mailing Address - Street 1:700 N DEVINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6964
Mailing Address - Country:US
Mailing Address - Phone:360-750-1385
Mailing Address - Fax:360-750-1385
Practice Address - Street 1:700 N DEVINE RD STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6964
Practice Address - Country:US
Practice Address - Phone:360-750-1385
Practice Address - Fax:360-750-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty