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NPI Code Detail

MEDICARE: DR. JASON A DOERSCHUK DDS

MEDICARE: DR. JASON A DOERSCHUK DDS
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
11223G0001XGeneral Practice Dentistry30021747OH

General Provider Information

NPI Number : 1659447951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON A DOERSCHUK DDS
Provider Business Mailing Address
First Line : 3817 W 160TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-4201
Country : US
Telephone Number : 216-671-6707
Fax Number : 216-671-8498
Provider Business Practice Location Address
First Line : 3817 W 160TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-4201
Country : US
Telephone Number : 216-671-6707
Fax Number : 216-671-8498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 07/08/2007

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Directions to “ DR. JASON A DOERSCHUK DDS” Practice Location

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