Healthcare Provider Details

I. General information

NPI: 1053630228
Provider Name (Legal Business Name): JASON ASHCROFT D.M.D., M.S.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 FM 156 S SUITE 100
HASLET TX
76052-3605
US

IV. Provider business mailing address

544 FM 156 S SUITE 100
HASLET TX
76052-3605
US

V. Phone/Fax

Practice location:
  • Phone: 817-439-4999
  • Fax:
Mailing address:
  • Phone: 817-439-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42000396A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS038116
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number27694
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: