Provider Demographics
NPI:1245310051
Name:DORMINEY, JASON (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:DORMINEY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 ELK GROVE FLORIN RD STE 180
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2267
Mailing Address - Country:US
Mailing Address - Phone:916-686-6900
Mailing Address - Fax:916-686-2069
Practice Address - Street 1:9727 ELK GROVE FLORIN RD STE 180
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2267
Practice Address - Country:US
Practice Address - Phone:916-686-6900
Practice Address - Fax:916-686-2069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA518631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics