Provider Demographics
NPI:1518168269
Name:HAWORTH, JASON ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:HAWORTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N MOONLIGHT RD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-2505
Mailing Address - Country:US
Mailing Address - Phone:913-856-7123
Mailing Address - Fax:913-856-7121
Practice Address - Street 1:115 N MOONLIGHT RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-2505
Practice Address - Country:US
Practice Address - Phone:913-856-7123
Practice Address - Fax:913-856-7121
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS604741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice