Provider Demographics
NPI:1871222497
Name:JURCA, JASON ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ADAM
Last Name:JURCA
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 1:300 W SNIDER ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1633
Mailing Address - Country:US
Mailing Address - Phone:307-701-4501
Mailing Address - Fax:
Practice Address - Street 1:620 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-2117
Practice Address - Country:US
Practice Address - Phone:307-684-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-54191223G0001X
WY16381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice