Provider Demographics
NPI:1770775322
Name:HULLETT, JASON (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HULLETT
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 1:24 GREENWAY PLZ
Mailing Address - Street 2:SUITE 1708
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-2401
Mailing Address - Country:US
Mailing Address - Phone:713-439-7575
Mailing Address - Fax:713-439-0924
Practice Address - Street 1:24 GREENWAY PLZ
Practice Address - Street 2:SUITE 1708
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-2401
Practice Address - Country:US
Practice Address - Phone:713-439-7575
Practice Address - Fax:713-439-0924
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625961223S0112X
TX310591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery