Provider Demographics
NPI:1346396298
Name:EVANS, JASON NEIL (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:NEIL
Last Name:EVANS
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 1:25 RED JACKET ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9517
Mailing Address - Country:US
Mailing Address - Phone:585-335-2201
Mailing Address - Fax:585-335-7243
Practice Address - Street 1:25 RED JACKET ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9517
Practice Address - Country:US
Practice Address - Phone:585-335-2201
Practice Address - Fax:585-335-7243
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046765-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice