Provider Demographics
NPI:1932477759
Name:JASON D WOOLSEY, DDS, PA
Entity Type:Organization
Organization Name:JASON D WOOLSEY, DDS, PA
Other - Org Name:WOOLSEY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WOOLSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-667-2090
Mailing Address - Street 1:1205 WEST COMMERCIAL ST.
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1205 WEST COMMERCIAL
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949
Practice Address - Country:US
Practice Address - Phone:479-667-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty