Provider Demographics
NPI:1265620561
Name:MAINES, JASON E (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:E
Last Name:MAINES
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 GINNALA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2701
Mailing Address - Country:US
Mailing Address - Phone:970-461-1994
Mailing Address - Fax:970-461-0809
Practice Address - Street 1:1331 E PROSPECT RD UNIT B1
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1367
Practice Address - Country:US
Practice Address - Phone:970-482-4916
Practice Address - Fax:970-221-5424
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics