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General NPI Number Information
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NPI Number | 1972612869
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Entity Type | Individual
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Provider Name | JASON L ALLEN DMD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 3707 WATSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63109-1236
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Country | US
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Telephone | 314-645-6400
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Fax | 314-787-4321
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Provider Business Mailing Address
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Address Line | 3707 WATSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63109-1236
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Country | US
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Telephone | 314-645-6400
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Fax | 314-787-4321
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2006000782
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License Number State | MO
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