Provider Demographics
NPI:1316968241
Name:MAUSETH, JASON ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ARTHUR
Last Name:MAUSETH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 YELLOWSTONE AVE
Mailing Address - Street 2:STE B1
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4374
Mailing Address - Country:US
Mailing Address - Phone:208-237-2462
Mailing Address - Fax:208-237-5297
Practice Address - Street 1:1246 YELLOWSTONE AVE
Practice Address - Street 2:STE B1
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4374
Practice Address - Country:US
Practice Address - Phone:208-237-2462
Practice Address - Fax:208-237-5297
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-39531223G0001X
AK11321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice