Provider Demographics
NPI:1831227503
Name:HALL, JASON R (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:HALL
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 1:6565 S YALE AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8360
Mailing Address - Country:US
Mailing Address - Phone:918-481-4925
Mailing Address - Fax:918-481-4931
Practice Address - Street 1:6565 S YALE AVE STE 1100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8360
Practice Address - Country:US
Practice Address - Phone:918-481-4925
Practice Address - Fax:918-481-4931
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice