Provider Demographics
NPI:1710171400
Name:AMES, JASON MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MATTHEW
Last Name:AMES
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 1:202 TRIBBLE GAP ROAD
Mailing Address - Street 2:104
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2540
Mailing Address - Country:US
Mailing Address - Phone:678-455-3360
Mailing Address - Fax:
Practice Address - Street 1:202 TRIBBLE GAP ROAD
Practice Address - Street 2:104
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:678-455-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist