Provider Demographics
NPI:1689728362
Name:DIGBY, JASON L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:DIGBY
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 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-1145
Mailing Address - Country:US
Mailing Address - Phone:662-862-6815
Mailing Address - Fax:662-862-6852
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-1145
Practice Address - Country:US
Practice Address - Phone:662-862-6815
Practice Address - Fax:662-862-6852
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3088-991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice