Basic Information
| Provider Information | |||||||||
| NPI: | 1366022063 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JASON A. FORD DMD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8667 US HIGHWAY 42 STE 100 | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410918759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593840393 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8667 US HIGHWAY 42 STE 100 | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410918759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593840393 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2021 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FORD | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8593840393 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DMD | ||||||||
| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.