Basic Information
| Provider Information | |||||||||
| NPI: | 1003002320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EKLUND | ||||||||
| FirstName: | D. | ||||||||
| MiddleName: | JASON | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.M.D. P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 OLD BRANDON RD | ||||||||
| Address2: | |||||||||
| City: | PEARL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392084702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019393561 | ||||||||
| FaxNumber: | 6019393583 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 OLD BRANDON RD | ||||||||
| Address2: | |||||||||
| City: | PEARL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392084702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019393561 | ||||||||
| FaxNumber: | 6019393583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 09/20/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 267192 | MS | Y | Dental Providers | Dentist | General Practice |
No ID Information.