Provider Demographics
NPI:1013957299
Name:CULLEY, JASON T (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:CULLEY
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 1:1225 DUBLIN RD.
Mailing Address - Street 2:SUITE 040
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-488-9050
Mailing Address - Fax:614-754-5219
Practice Address - Street 1:1225 DUBLIN RD.
Practice Address - Street 2:SUITE 040
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-488-9050
Practice Address - Fax:614-754-5219
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH217451223G0001X
OH300217451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164471OtherUCCI PROVIDER #