Provider Demographics
NPI:1588874903
Name:RINGEMAN, JASON L (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:RINGEMAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4012
Mailing Address - Country:US
Mailing Address - Phone:336-768-9881
Mailing Address - Fax:336-768-6066
Practice Address - Street 1:3020 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4012
Practice Address - Country:US
Practice Address - Phone:336-768-9881
Practice Address - Fax:336-768-6066
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN92831223S0112X
TN47509204E00000X
NC2011-005451223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07056Medicaid