Healthcare Provider Details

I. General information

NPI: 1952350118
Provider Name (Legal Business Name): JASON ANDREW MESSINGHAM DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 S 8TH ST
COLORADO SPRINGS CO
80906-1307
US

IV. Provider business mailing address

1050 S 8TH ST
COLORADO SPRINGS CO
80906-1307
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-2807
  • Fax: 719-635-2965
Mailing address:
  • Phone: 719-635-2807
  • Fax: 719-635-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8555
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: