Provider Demographics
NPI:1467672972
Name:LANDERS, JASON MASCHAL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MASCHAL
Last Name:LANDERS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 E RAINFOREST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5385
Mailing Address - Country:US
Mailing Address - Phone:479-582-0600
Mailing Address - Fax:479-443-4630
Practice Address - Street 1:1607 E RAINFOREST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5385
Practice Address - Country:US
Practice Address - Phone:479-582-0600
Practice Address - Fax:479-443-4630
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1541223X0400X
AR34121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A640OtherBCBS - INDIVIDUAL
OK200046160AOtherSOONERCARE - INDIVIDUAL