MEDICARE: JASON EHTESSABIAN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1215874490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON EHTESSABIAN PLLC

Provider Business Mailing Address
First Line	:	3740 DACORO LN STE 140
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-2504
Country	:	US
Telephone Number	:	720-868-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 DACORO LN STE 140
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-2504
Country	:	US
Telephone Number	:	720-868-0888
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASON EHTESSABIAN
Credential	:	DDS
Telephone Number	:	719-342-3806

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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