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NPI Code Detail

MEDICARE: JASON SPEARS D.D.S.

MEDICARE: JASON SPEARS D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN 20514FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053737049
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON SPEARS D.D.S.
Provider Business Mailing Address
First Line : PO BOX 1357
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-1357
Country : US
Telephone Number : 239-278-3600
Fax Number : 239-226-4650
Provider Business Practice Location Address
First Line : 4300 KINGS HWY
Second Line : SUITE 500
City : PORT CHARLOTTE
State : FL
Zip : 33980-2917
Country : US
Telephone Number : 239-344-2337
Fax Number : 941-629-2365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2014
Last Update Date : 05/04/2017

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Directions to “ JASON SPEARS D.D.S.” Practice Location

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