Provider Demographics
NPI:1669482097
Name:VANWAGENEN, JASON RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RONALD
Last Name:VANWAGENEN
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 1:1557 W 84TH AVE SUITE 1
Mailing Address - Street 2:
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260
Mailing Address - Country:US
Mailing Address - Phone:303-426-4860
Mailing Address - Fax:303-426-1530
Practice Address - Street 1:1557 W 84TH AVE SUITE 1
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260
Practice Address - Country:US
Practice Address - Phone:303-426-4860
Practice Address - Fax:303-426-1530
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice