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General NPI Number Information
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NPI Number | 1467642082
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Entity Type | Organization
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Legal Business Name | JASON T GLADWELL D.D,S., P.A.
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 2824 ROGERS RD SUITE 200
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City | WAKE FOREST
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State | NC
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Zip | 27587
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Country | US
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Telephone | 919-923-8513
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Fax |
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Provider Business Mailing Address
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Address Line | 3650 ROGERS RD #330
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City | WAKE FOREST
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State | NC
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Zip | 27587-9306
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Country | US
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Telephone | 919-923-8513
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Fax |
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Authorized Official
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Title or Position | CEO/ ORTHODONTIST
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Name | DR. JASON THOMAS GLADWELL
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Credential | D.D.S., M.S.D.
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Telephone | 919-923-8513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7981
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License Number State | NC
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