Provider Demographics
NPI:1295724235
Name:SAMMONS, S. JASON (DMD)
Entity type:Individual
Prefix:DR
First Name:S.
Middle Name:JASON
Last Name:SAMMONS
Suffix:
Gender:M
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:PO BOX 10517
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0108
Mailing Address - Country:US
Mailing Address - Phone:731-668-7412
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2157
Practice Address - Country:US
Practice Address - Phone:731-668-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN78481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery