Provider Demographics
NPI:1659380996
Name:ATHA, JASON JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMES
Last Name:ATHA
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 1:11132 CHASE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3285
Mailing Address - Country:US
Mailing Address - Phone:303-484-8581
Mailing Address - Fax:303-494-2281
Practice Address - Street 1:350 BROADWAY ST
Practice Address - Street 2:SUITE 10
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3343
Practice Address - Country:US
Practice Address - Phone:303-494-8200
Practice Address - Fax:303-494-2281
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice