Provider Demographics
NPI:1376617662
Name:MOUNTS, JASON RANDALL (DMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RANDALL
Last Name:MOUNTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:R
Other - Last Name:MOUNTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, PA
Mailing Address - Street 1:2501 CRESTWOOD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6864
Mailing Address - Country:US
Mailing Address - Phone:501-753-0166
Mailing Address - Fax:501-753-1071
Practice Address - Street 1:2501 CRESTWOOD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6864
Practice Address - Country:US
Practice Address - Phone:501-753-0166
Practice Address - Fax:501-753-1071
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3450122300000X
FL16402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist