Provider Demographics
NPI:1720182884
Name:HERRING, JASON ANTHONY (DDS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANTHONY
Last Name:HERRING
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:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635
Mailing Address - Country:US
Mailing Address - Phone:870-364-3313
Mailing Address - Fax:870-364-9433
Practice Address - Street 1:909 A UNITY ROAD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635
Practice Address - Country:US
Practice Address - Phone:870-364-3313
Practice Address - Fax:870-364-9433
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice