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General NPI Number Information
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NPI Number | 1629335013
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Entity Type | Organization
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Legal Business Name | JASON J. JUAREZ, D.D.S., INC.
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 1075 E 2ND ST
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City | DEFIANCE
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State | OH
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Zip | 43512-2431
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Country | US
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Telephone | 419-782-1126
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Fax | 419-782-8790
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Provider Business Mailing Address
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Address Line | 1075 E 2ND ST
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City | DEFIANCE
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State | OH
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Zip | 43512-2431
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Country | US
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Telephone | 419-782-1126
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Fax | 419-782-8790
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JASON JESSE JUAREZ
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Credential | D.D.S.
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Telephone | 419-782-1126
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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 |
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License Number State |
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