=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932477759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JASON D WOOLSEY, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2011
-----------------------------------------------------
Last Update Date | 12/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1205 WEST COMMERCIAL
-----------------------------------------------------
City | OZARK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-667-2090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 WEST COMMERCIAL ST.
-----------------------------------------------------
City | OZARK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JASON DANIEL WOOLSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 479-667-2090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3705
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------