Provider Demographics
NPI:1902834674
Name:DOUCETTE, JASON RYAN (DMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RYAN
Last Name:DOUCETTE
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:PO BOX 10408
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-2408
Mailing Address - Country:US
Mailing Address - Phone:775-588-5183
Mailing Address - Fax:
Practice Address - Street 1:120 MCFAUL WAY
Practice Address - Street 2:
Practice Address - City:ZEPHYR COVE
Practice Address - State:NV
Practice Address - Zip Code:89448
Practice Address - Country:US
Practice Address - Phone:775-588-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV34761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV88-0434942OtherTAX ID