Provider Demographics
NPI:1467642082
Name:JASON T GLADWELL D.D,S., P.A.
Entity Type:Organization
Organization Name:JASON T GLADWELL D.D,S., P.A.
Other - Org Name:GLADWELL ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GLADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:919-923-8513
Mailing Address - Street 1:3650 ROGERS RD
Mailing Address - Street 2:#330
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9306
Mailing Address - Country:US
Mailing Address - Phone:919-923-8513
Mailing Address - Fax:
Practice Address - Street 1:2824 ROGERS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-923-8513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty