Provider Demographics
NPI:1649761115
Name:SCHLUETER, JASON THEODORE (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:THEODORE
Last Name:SCHLUETER
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 1:159 S WILDWOOD RUN APT 17
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-8768
Mailing Address - Country:US
Mailing Address - Phone:231-357-0912
Mailing Address - Fax:
Practice Address - Street 1:409 W LUDINGTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2377
Practice Address - Country:US
Practice Address - Phone:231-845-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010225881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice