Provider Demographics
NPI:1992715148
Name:ROE, JASON D (DDS, FACP)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:ROE
Suffix:
Gender:M
Credentials:DDS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5136 VILLAGE CREEK DR STE 501
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4460
Mailing Address - Country:US
Mailing Address - Phone:972-931-1777
Mailing Address - Fax:972-931-8259
Practice Address - Street 1:5136 VILLAGE CREEK DR STE 501
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4460
Practice Address - Country:US
Practice Address - Phone:972-931-1777
Practice Address - Fax:972-931-8259
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22741122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist