Provider Demographics
NPI:1700926227
Name:KLINGENSMITH, JASON SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SCOTT
Last Name:KLINGENSMITH
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 1:1009 CAPABILITY DR
Mailing Address - Street 2:BUILDING 2, SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-5515
Mailing Address - Country:US
Mailing Address - Phone:919-515-8979
Mailing Address - Fax:
Practice Address - Street 1:1009 CAPABILITY DR
Practice Address - Street 2:BUILDING 2, SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-5515
Practice Address - Country:US
Practice Address - Phone:919-515-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8511122300000X
PADS031317L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice