Provider Demographics
NPI:1184836504
Name:DUGGAN, JASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:DUGGAN
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 1:1500 W 38TH ST
Mailing Address - Street 2:STE. 10
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6321
Mailing Address - Country:US
Mailing Address - Phone:512-380-0777
Mailing Address - Fax:512-380-0778
Practice Address - Street 1:1500 W 38TH ST
Practice Address - Street 2:STE. 10
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6321
Practice Address - Country:US
Practice Address - Phone:512-380-0777
Practice Address - Fax:512-380-0778
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics