Provider Demographics
NPI:1578934717
Name:REESOR, JASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:REESOR
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 1:4007 CRESCENT POINT RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3610
Mailing Address - Country:US
Mailing Address - Phone:661-477-5168
Mailing Address - Fax:
Practice Address - Street 1:326 S MELROSE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6618
Practice Address - Country:US
Practice Address - Phone:760-216-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist