Provider Demographics
NPI:1336289248
Name:POWELL, JASON WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:POWELL
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 1:7250 PARKWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1388
Mailing Address - Country:US
Mailing Address - Phone:410-567-5520
Mailing Address - Fax:410-712-4762
Practice Address - Street 1:7250 PARKWAY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1388
Practice Address - Country:US
Practice Address - Phone:410-567-5520
Practice Address - Fax:410-712-4762
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410627122300000X
WV3611122300000X
MD14739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist