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General NPI Number Information
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NPI Number | 1578622908
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Entity Type | Individual
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Provider Name | JASON LEE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 4257 POINT LA VISTA RD W
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City | JACKSONVILLE
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State | FL
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Zip | 32207-6247
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Country | US
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Telephone | 904-703-2236
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Fax |
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Provider Business Mailing Address
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Address Line | 4257 POINT LA VISTA RD W
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City | JACKSONVILLE
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State | FL
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Zip | 32207-6247
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Country | US
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Telephone | 904-703-2236
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DTP477
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D7521
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN18554
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License Number State | FL
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