Healthcare Provider Details

I. General information

NPI: 1467622449
Provider Name (Legal Business Name): JASON EDWARD FORD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2533 LARKIN RD SUITE 101
LEXINGTON KY
40503-3278
US

IV. Provider business mailing address

2533 LARKIN RD SUITE 101
LEXINGTON KY
40503-3278
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-9376
  • Fax:
Mailing address:
  • Phone: 859-278-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7857
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number7857
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: