Provider Demographics
NPI:1932331063
Name:GARNER, JASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:GARNER
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 1:3650 CHAMBERS PASS BLDG 3610
Mailing Address - Street 2:
Mailing Address - City:JBSA-FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6315
Mailing Address - Country:US
Mailing Address - Phone:210-539-9453
Mailing Address - Fax:
Practice Address - Street 1:1100 WILFORD HALL LOOP BLDG 4554
Practice Address - Street 2:
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-5638
Practice Address - Country:US
Practice Address - Phone:210-539-9453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011324A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist