Provider Demographics
NPI:1790859767
Name:DAHL, JASON O (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:O
Last Name:DAHL
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 1:1119 SIMS ST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601
Mailing Address - Country:US
Mailing Address - Phone:701-227-1193
Mailing Address - Fax:701-225-1163
Practice Address - Street 1:1119 SIMS ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601
Practice Address - Country:US
Practice Address - Phone:701-227-1193
Practice Address - Fax:701-225-1163
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND18831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND971883OtherBLUE CROSS BLUE SHIELD ND
ND41275Medicaid
U75291Medicare UPIN