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General NPI Number Information
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NPI Number | 1790835015
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Entity Type | Organization
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Legal Business Name | JASON AANENSON, DDS, PC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 E. 5TH STREET
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City | FREEMAN
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State | SD
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Zip | 57029
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Country | US
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Telephone | 605-925-4999
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Fax | 605-925-4196
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Provider Business Mailing Address
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Address Line | 105 E. 5TH STREET PO BOX 219
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City | FREEMAN
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State | SD
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Zip | 57029
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Country | US
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Telephone | 605-925-4999
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Fax | 605-925-4196
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Authorized Official
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Title or Position | OWNER
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Name | JASON AANENSON
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Credential | D.D.S.
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Telephone | 605-925-4999
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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 | M-879
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License Number State | SD
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