1861586919 NPI number — S. JASON TROUTMAN D.D.S., PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861586919 NPI number — S. JASON TROUTMAN D.D.S., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S. JASON TROUTMAN D.D.S., PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861586919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MEBANE OAKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEBANE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27302-9643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-563-5939
Provider Business Mailing Address Fax Number:
919-563-6676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MEBANE OAKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEBANE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27302-9643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-563-5939
Provider Business Practice Location Address Fax Number:
919-563-6676
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TROUTMAN
Authorized Official First Name:
S
Authorized Official Middle Name:
JASON
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
919-563-5939

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  8187 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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