Provider Demographics
NPI:1437233459
Name:ROCHE, JASON CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHARLES
Last Name:ROCHE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 EASTSIDE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3477
Mailing Address - Country:US
Mailing Address - Phone:402-223-4140
Mailing Address - Fax:402-228-1762
Practice Address - Street 1:110 EASTSIDE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3477
Practice Address - Country:US
Practice Address - Phone:402-223-4140
Practice Address - Fax:402-228-1762
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist