Provider Demographics
NPI:1730280181
Name:MANCHESTER, JASON P (DMD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:P
Last Name:MANCHESTER
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 1:3830 S HIGHWAY A1A
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951
Mailing Address - Country:US
Mailing Address - Phone:321-728-0025
Mailing Address - Fax:321-724-6538
Practice Address - Street 1:3830 S HIGHWAY A1A
Practice Address - Street 2:SUITE 1
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951
Practice Address - Country:US
Practice Address - Phone:321-728-0025
Practice Address - Fax:321-724-6538
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice