Provider Demographics
NPI:1932697117
Name:ALSBURY, JASON LEE
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEE
Last Name:ALSBURY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 CREEKSIDE LOOP STE 110
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4880
Mailing Address - Country:US
Mailing Address - Phone:509-204-8305
Mailing Address - Fax:509-204-8045
Practice Address - Street 1:3909 CREEKSIDE LOOP STE 110
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4880
Practice Address - Country:US
Practice Address - Phone:509-204-8305
Practice Address - Fax:509-204-8045
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60833384122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist