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General NPI Number Information
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NPI Number | 1215874490
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Entity Type | Organization
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Legal Business Name | JASON EHTESSABIAN PLLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 3740 DACORO LN STE 140
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City | CASTLE ROCK
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State | CO
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Zip | 80109-2504
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Country | US
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Telephone | 720-868-0888
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Fax |
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Provider Business Mailing Address
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Address Line | 3740 DACORO LN STE 140
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City | CASTLE ROCK
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State | CO
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Zip | 80109-2504
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Country | US
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Telephone | 720-868-0888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASON EHTESSABIAN
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Credential | DDS
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Telephone | 719-342-3806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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