Individual
JASON BLAINE STREETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1685 BRIARGATE BLVD, COLORADO SPRINGS, CO 80920-3464
(719) 590-7277
(719) 590-7278
Mailing address
4159 PARK HAVEN VW, COLORADO SPRINGS, CO 80917-2604
(208) 431-4187
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
00203180
CO
Other
Enumeration date
06/05/2017
Last updated
06/05/2017
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