Provider Demographics
NPI:1871667543
Name:WEST, JASON D (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:WEST
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE #140
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3249
Mailing Address - Country:US
Mailing Address - Phone:281-681-2422
Mailing Address - Fax:866-352-0357
Practice Address - Street 1:1011 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE #140
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3249
Practice Address - Country:US
Practice Address - Phone:281-681-2422
Practice Address - Fax:866-352-0357
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist