Provider Demographics
NPI:1336543198
Name:JASON STOTT DDS PROFESSIONAL LLC
Entity type:Organization
Organization Name:JASON STOTT DDS PROFESSIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-222-0755
Mailing Address - Street 1:15805 LONGFORD DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7563
Mailing Address - Country:US
Mailing Address - Phone:716-222-0755
Mailing Address - Fax:
Practice Address - Street 1:280 EAST COLFAX AVENUE
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102
Practice Address - Country:US
Practice Address - Phone:716-222-0755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002020241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty