Provider Demographics
NPI:1285133801
Name:DEDEK-KEELER, JASON ANDREW
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:DEDEK-KEELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 HEALTH SCIENCES BLDG.
Mailing Address - Street 2:3640 COLONEL GLENN HWY.
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435
Mailing Address - Country:US
Mailing Address - Phone:937-775-3458
Mailing Address - Fax:937-775-3434
Practice Address - Street 1:117 HEALTH SCIENCES BLDG.
Practice Address - Street 2:3640 COLONEL GLENN HWY.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45435
Practice Address - Country:US
Practice Address - Phone:937-775-3458
Practice Address - Fax:937-775-3434
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program