Provider Demographics
NPI:1962633917
Name:FOLLETT, JASON ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ADAM
Last Name:FOLLETT
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 1:204 RESIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-1607
Mailing Address - Country:US
Mailing Address - Phone:541-426-3531
Mailing Address - Fax:541-426-8411
Practice Address - Street 1:204 RESIDENCE ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1607
Practice Address - Country:US
Practice Address - Phone:541-426-3531
Practice Address - Fax:541-426-8411
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist