Provider Demographics
NPI:1710292040
Name:MCDANIEL, JASON NMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:NMI
Last Name:MCDANIEL
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 1:2901 CASSIDY RD
Mailing Address - Street 2:
Mailing Address - City:FORT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79916-3502
Mailing Address - Country:US
Mailing Address - Phone:915-742-6083
Mailing Address - Fax:
Practice Address - Street 1:CHAMBERS DENTAL CLINIC 11334 SSG SIMS ST.
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79908
Practice Address - Country:US
Practice Address - Phone:915-742-6072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7718094-9921122300000X
TX383941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist