Provider Demographics
NPI:1457088965
Name:TUPPER, JASON JOHN (BDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOHN
Last Name:TUPPER
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 SOUTH HIGHLAND STREET
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTRE
Practice Address - Street 2:875 UNION AVE DUNN BUILDING,
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103
Practice Address - Country:US
Practice Address - Phone:901-448-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2023-11-28
Deactivation Date:2023-03-13
Deactivation Code:
Reactivation Date:2023-11-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program