Provider Demographics
NPI:1689022675
Name:JSPAXON DENTAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:JSPAXON DENTAL MANAGEMENT, LLC
Other - Org Name:MCKEES ROCKS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-463-8284
Mailing Address - Street 1:757 CHARTIERS AVE
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-3622
Mailing Address - Country:US
Mailing Address - Phone:412-331-4629
Mailing Address - Fax:
Practice Address - Street 1:757 CHARTIERS AVE
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-3622
Practice Address - Country:US
Practice Address - Phone:412-331-4629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty