Provider Demographics
NPI:1205097045
Name:NEW, JASON CODY (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CODY
Last Name:NEW
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:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:VALLEY MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76689-0127
Mailing Address - Country:US
Mailing Address - Phone:254-932-6404
Mailing Address - Fax:
Practice Address - Street 1:701 AVE C
Practice Address - Street 2:
Practice Address - City:VALLEY MILLS
Practice Address - State:TX
Practice Address - Zip Code:76689-0127
Practice Address - Country:US
Practice Address - Phone:254-932-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice