Provider Demographics
NPI:1902834674
Name:DOUCETTE, JASON RYAN (DMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:RYAN
Last Name:DOUCETTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SANDHILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8963
Mailing Address - Country:US
Mailing Address - Phone:775-477-5337
Mailing Address - Fax:775-360-4131
Practice Address - Street 1:730 SANDHILL RD STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8963
Practice Address - Country:US
Practice Address - Phone:775-477-5337
Practice Address - Fax:775-360-4131
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV34761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV88-0434942OtherTAX ID