Provider Demographics
NPI:1588772503
Name:MEARES, R, JASON (DDS)
Entity type:Individual
Prefix:DR
First Name:R,
Middle Name:JASON
Last Name:MEARES
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 1:17 HIGH COTTON LN
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6500
Mailing Address - Country:US
Mailing Address - Phone:843-357-2122
Mailing Address - Fax:843-357-2124
Practice Address - Street 1:767 WACHESAW RD
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5813
Practice Address - Country:US
Practice Address - Phone:843-357-2122
Practice Address - Fax:843-357-2124
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33891223G0001X
NC65901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice