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General NPI Number Information
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NPI Number | 1699069377
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Entity Type | Organization
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Legal Business Name | JASON JETER & LAGELLE JETER DDS, INC.
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 805 W. ACEQUIA AVE #2B
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City | VISALIA
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State | CA
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Zip | 93291-6164
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Country | US
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Telephone | 559-739-8400
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Fax | 559-739-8333
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Provider Business Mailing Address
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Address Line | 805 W. ACEQUIA AVE #2B
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City | VISALIA
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State | CA
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Zip | 93291-6164
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Country | US
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Telephone | 559-739-8400
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Fax | 559-739-8333
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Authorized Official
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Title or Position | CO OWNER
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Name | DR. JASON L JETER
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Credential | DDS
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Telephone | 559-739-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23523
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License Number State | CA
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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 | 46614
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License Number State | CA
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