Provider Demographics
NPI:1982814968
Name:LEROUX, JASON CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:LEROUX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N SANTA ROSA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1324
Mailing Address - Country:US
Mailing Address - Phone:805-543-3747
Mailing Address - Fax:805-543-3914
Practice Address - Street 1:225 N SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1324
Practice Address - Country:US
Practice Address - Phone:805-543-3747
Practice Address - Fax:805-543-3914
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice