Provider Demographics
NPI:1487690160
Name:MCGOVERN, JASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-1349
Mailing Address - Country:US
Mailing Address - Phone:229-382-0803
Mailing Address - Fax:229-382-0809
Practice Address - Street 1:1413 TIFT AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3546
Practice Address - Country:US
Practice Address - Phone:229-382-0803
Practice Address - Fax:229-382-0809
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist