Provider Demographics
NPI:1881142149
Name:WILLIAMS, JASON (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:WILLIAMS
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 1:1725 MAIN ST UNIT 2313
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8165
Mailing Address - Country:US
Mailing Address - Phone:954-478-9319
Mailing Address - Fax:
Practice Address - Street 1:10009 BROADWAY ST STE 107
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9757
Practice Address - Country:US
Practice Address - Phone:713-436-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2022-07-21
Deactivation Date:2019-02-20
Deactivation Code:
Reactivation Date:2019-02-25
Provider Licenses
StateLicense IDTaxonomies
TX321751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice