Individual
JASON D PICKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
117 W SEVIER AVE, SUITE 220, KINGSPORT, TN 37660-3799
(423) 224-3200
(423) 224-3208
Mailing address
117 W SEVIER AVE, SUITE 220, KINGSPORT, TN 37660-3799
(423) 224-3200
(423) 224-3208
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
9613
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1532052
—
TN
Enumeration date
04/07/2009
Last updated
08/13/2013
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