Provider Demographics
NPI:1619072139
Name:NEDZINSKI, JASON DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DAVID
Last Name:NEDZINSKI
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 1:1082 S MICHAEL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3003
Mailing Address - Country:US
Mailing Address - Phone:814-781-1212
Mailing Address - Fax:
Practice Address - Street 1:1082 S MICHAEL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3003
Practice Address - Country:US
Practice Address - Phone:814-781-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0355321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice