Provider Demographics
NPI:1356577613
Name:DULAC, JASON W (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:DULAC
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 1:6124 BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2610
Mailing Address - Country:US
Mailing Address - Phone:703-451-4500
Mailing Address - Fax:703-451-7164
Practice Address - Street 1:6124 BRANDON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2610
Practice Address - Country:US
Practice Address - Phone:703-451-4500
Practice Address - Fax:703-451-7164
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020024122300000X
VA0401414685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist