Provider Demographics
NPI:1285851014
Name:ROAN, JASON J (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:ROAN
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 1:218 W BELL ST STE 102
Mailing Address - Street 2:PO BOX 1171
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1644
Mailing Address - Country:US
Mailing Address - Phone:406-377-2303
Mailing Address - Fax:406-377-3950
Practice Address - Street 1:218 W BELL ST STE 102
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1644
Practice Address - Country:US
Practice Address - Phone:406-377-2303
Practice Address - Fax:406-377-3950
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice