Provider Demographics
NPI:1396814042
Name:LINK, JASON (GENERAL DENTIST)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:LINK
Suffix:
Gender:M
Credentials:GENERAL DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-1131
Mailing Address - Country:US
Mailing Address - Phone:814-381-5646
Mailing Address - Fax:
Practice Address - Street 1:811 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1131
Practice Address - Country:US
Practice Address - Phone:814-224-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice