Provider Demographics
NPI:1619096310
Name:SEO, JASON H (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:H
Last Name:SEO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 RATZER RD
Mailing Address - Street 2:SUITE C-22
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7702
Mailing Address - Country:US
Mailing Address - Phone:973-696-5258
Mailing Address - Fax:973-696-5290
Practice Address - Street 1:330 RATZER RD
Practice Address - Street 2:SUITE C-22
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7702
Practice Address - Country:US
Practice Address - Phone:973-696-5258
Practice Address - Fax:973-696-5290
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0198601223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics