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General NPI Number Information
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NPI Number | 1184119182
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Entity Type | Individual
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Provider Name | JASON FUAH DMD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 823 N BROADWAY ST
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City | SPRING VALLEY
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State | MN
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Zip | 55975-1029
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Country | US
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Telephone | 507-346-7281
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Fax |
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Provider Business Mailing Address
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Address Line | 823 N BROADWAY ST
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City | SPRING VALLEY
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State | MN
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Zip | 55975-1029
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Country | US
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Telephone | 507-346-7281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.025475
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License Number State | OH
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