Provider Demographics
NPI:1629335013
Name:JASON J. JUAREZ, D.D.S., INC.
Entity Type:Organization
Organization Name:JASON J. JUAREZ, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-782-1126
Mailing Address - Street 1:1075 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2431
Mailing Address - Country:US
Mailing Address - Phone:419-782-1126
Mailing Address - Fax:419-782-8790
Practice Address - Street 1:1075 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2431
Practice Address - Country:US
Practice Address - Phone:419-782-1126
Practice Address - Fax:419-782-8790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty