Provider Demographics
NPI:1578747572
Name:JASON T. CULLEY D.D.S. INC
Entity Type:Organization
Organization Name:JASON T. CULLEY D.D.S. INC
Other - Org Name:WATERMARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:CULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-488-9050
Mailing Address - Street 1:1225 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1024
Mailing Address - Country:US
Mailing Address - Phone:614-488-9050
Mailing Address - Fax:614-488-9120
Practice Address - Street 1:1225 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1024
Practice Address - Country:US
Practice Address - Phone:614-488-9050
Practice Address - Fax:614-488-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0217451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty