Provider Demographics
NPI:1437315702
Name:MARGOLIS, JASON ISAAC (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ISAAC
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:621 SOUTH NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 16 A
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-6725
Mailing Address - Fax:314-251-6726
Practice Address - Street 1:621 SOUTH NEW BALLAS ROAD
Practice Address - Street 2:SUITE 16 A
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-6725
Practice Address - Fax:314-251-6726
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20110377531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery