Provider Demographics
NPI:1235426396
Name:TEERLINK, JASON (DMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:TEERLINK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 W 6200 S STE A6
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-7920
Mailing Address - Country:US
Mailing Address - Phone:801-955-1112
Mailing Address - Fax:801-963-4736
Practice Address - Street 1:5633 W 6200 S STE A6
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-7920
Practice Address - Country:US
Practice Address - Phone:801-955-1112
Practice Address - Fax:801-963-4736
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8033235-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist