Provider Demographics
NPI:1528501988
Name:JASON W. DULAC, DDS, PLLC
Entity type:Organization
Organization Name:JASON W. DULAC, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DULAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-340-7674
Mailing Address - Street 1:6124 BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2610
Mailing Address - Country:US
Mailing Address - Phone:703-451-4500
Mailing Address - Fax:703-451-7164
Practice Address - Street 1:6124 BRANDON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2610
Practice Address - Country:US
Practice Address - Phone:703-451-4500
Practice Address - Fax:703-451-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty