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Individual

JASON AARON DEWITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
2204 SCOTT ST, LAFAYETTE, IN 47904-2933
(765) 447-0525
(765) 447-5815
Mailing address
2204 SCOTT ST, LAFAYETTE, IN 47904-2933
(765) 447-0525
(765) 447-5815

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12010545A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12010545A
DENTAL LICENSE
IN
Enumeration date
04/03/2007
Last updated
09/28/2010
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