Provider Demographics
NPI:1255473328
Name:MCNABB, JASON BYRON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BYRON
Last Name:MCNABB
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 1:3227 BROECK POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2569
Mailing Address - Country:US
Mailing Address - Phone:502-326-3562
Mailing Address - Fax:
Practice Address - Street 1:8517 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5301
Practice Address - Country:US
Practice Address - Phone:502-966-4367
Practice Address - Fax:502-966-4001
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice