Provider Demographics
NPI:1508016825
Name:PRESCOTT, JASON ERVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ERVIN
Last Name:PRESCOTT
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 1:1051 JOHNNIE DODDS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3100
Mailing Address - Country:US
Mailing Address - Phone:843-388-9690
Mailing Address - Fax:843-388-9703
Practice Address - Street 1:1051 JOHNNIE DODDS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3100
Practice Address - Country:US
Practice Address - Phone:843-388-9690
Practice Address - Fax:843-388-9703
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice