Provider Demographics
NPI:1962630087
Name:DASHOW, JASON (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:DASHOW
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 LAKE OTIS PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5226
Mailing Address - Country:US
Mailing Address - Phone:907-764-4760
Mailing Address - Fax:907-764-4762
Practice Address - Street 1:4200 LAKE OTIS PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5226
Practice Address - Country:US
Practice Address - Phone:907-764-4760
Practice Address - Fax:907-764-4762
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK108546204E00000X
AK108819204E00000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2388525Medicaid
LA545402YH54Medicare PIN