Provider Demographics
NPI:1679675508
Name:STRANGE, JASON (DMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:STRANGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY DENTAL ACTIVITY CREDENTIALS
Mailing Address - Street 2:9900 LINCOLN STREET 2ND FLOOR
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-4039
Mailing Address - Fax:253-782-4039
Practice Address - Street 1:US ARMY DENTAL ACTIVITY CREDENTIALS
Practice Address - Street 2:9900 LINCOLN STREET 2ND FLOOR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-4039
Practice Address - Fax:253-782-4039
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3067-98122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist