Provider Demographics
NPI:1811214059
Name:JERAN, JASON PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:PAUL
Last Name:JERAN
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 1:6132 W CREEK RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2130
Mailing Address - Country:US
Mailing Address - Phone:216-524-8481
Mailing Address - Fax:
Practice Address - Street 1:6132 W CREEK RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2130
Practice Address - Country:US
Practice Address - Phone:216-524-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0230721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice