Provider Demographics
NPI:1437887254
Name:JASON D ROE, DDS, PLLC
Entity Type:Organization
Organization Name:JASON D ROE, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-931-1777
Mailing Address - Street 1:5136 VILLAGE CREEK DR STE 501
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4460
Mailing Address - Country:US
Mailing Address - Phone:972-931-1777
Mailing Address - Fax:
Practice Address - Street 1:5136 VILLAGE CREEK DR STE 501
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4460
Practice Address - Country:US
Practice Address - Phone:972-931-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22741OtherTEXAS STATE DENTAL BOARD