Healthcare Provider Details

I. General information

NPI: 1013061787
Provider Name (Legal Business Name): JASON LEE EHLERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W 4TH ST
DELL RAPIDS SD
57022-1508
US

IV. Provider business mailing address

108 W 4TH ST
DELL RAPIDS SD
57022-1508
US

V. Phone/Fax

Practice location:
  • Phone: 604-428-5471
  • Fax: 605-428-4804
Mailing address:
  • Phone: 604-428-5471
  • Fax: 605-428-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberM934
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: