Individual
DR. JASON KYLE HARTUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
505 HARMON LOOP RD, SUITE 300, DEDEDO, GU 96929-6519
(671) 482-2936
Mailing address
505 HARMON LOOP RD, SUITE 300, DEDEDO, GU 96929-6519
(671) 482-2936
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
56525
CA
122300000X
Dentist
Primary
D1009
GU
1223G0001X
General Practice Dentistry
66512788903
UT
Other
Enumeration date
03/29/2008
Last updated
04/25/2013
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