Provider Demographics
NPI:1710334222
Name:JASON S BRESTER DDS PLLC
Entity Type:Organization
Organization Name:JASON S BRESTER DDS PLLC
Other - Org Name:BRESTER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-840-6998
Mailing Address - Street 1:403 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2037
Mailing Address - Country:US
Mailing Address - Phone:360-834-2182
Mailing Address - Fax:
Practice Address - Street 1:403 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2037
Practice Address - Country:US
Practice Address - Phone:360-834-2182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60393681261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental