Provider Demographics
NPI:1629316401
Name:JASON A FOLLETT DMD PC
Entity Type:Organization
Organization Name:JASON A FOLLETT DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-426-3531
Mailing Address - Street 1:204 RESIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-1607
Mailing Address - Country:US
Mailing Address - Phone:541-426-3531
Mailing Address - Fax:541-426-8411
Practice Address - Street 1:204 RESIDENCE ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1607
Practice Address - Country:US
Practice Address - Phone:541-426-3531
Practice Address - Fax:541-426-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty