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General NPI Number Information
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NPI Number | 1356577613
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Entity Type | Individual
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Provider Name | JASON W DULAC DDS
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Gender | Male
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 6124 BRANDON AVE
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2610
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Country | US
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Telephone | 703-451-4500
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Fax | 703-451-7164
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Provider Business Mailing Address
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Address Line | 6124 BRANDON AVE
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2610
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Country | US
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Telephone | 703-451-4500
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Fax | 703-451-7164
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901020024
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401414685
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License Number State | VA
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