Healthcare Provider Details

I. General information

NPI: 1659493815
Provider Name (Legal Business Name): JOHN JASON BIGBY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 PARAGON RD SUITE 203
DAYTON OH
45459-5318
US

IV. Provider business mailing address

7501 PARAGON RD SUITE 203
DAYTON OH
45459-5318
US

V. Phone/Fax

Practice location:
  • Phone: 937-291-0022
  • Fax: 937-291-0190
Mailing address:
  • Phone: 937-291-0022
  • Fax: 937-291-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number30-02-1668
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: