Provider Demographics
NPI:1770776809
Name:EHTESSABIAN, JASON (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:EHTESSABIAN
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 1:3740 DACORO LN
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2503
Mailing Address - Country:US
Mailing Address - Phone:303-688-6630
Mailing Address - Fax:303-663-6534
Practice Address - Street 1:3740 DACORO LN
Practice Address - Street 2:SUITE 140
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2503
Practice Address - Country:US
Practice Address - Phone:303-688-6630
Practice Address - Fax:303-663-6534
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist