Individual
JASON DALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1928 COMMERCE LN STE 1, JUPITER, FL 33458-5598
(561) 210-7333
(561) 529-2618
Mailing address
438 NE 2ND AVE, FT LAUDERDALE, FL 33301-3270
(954) 683-8153
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN 21447
FL
1223P0221X
Pediatric Dentistry
Primary
DN21447
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024664900
—
FL
Enumeration date
11/17/2015
Last updated
01/23/2019
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