Provider Demographics
NPI:1952418832
Name:PATE, JASON A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:PATE
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 1:415 DUNSTAN AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2321
Mailing Address - Country:US
Mailing Address - Phone:919-680-3368
Mailing Address - Fax:919-687-7734
Practice Address - Street 1:415 DUNSTAN AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2321
Practice Address - Country:US
Practice Address - Phone:919-680-3368
Practice Address - Fax:919-687-7734
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902N2Medicaid