Provider Demographics
NPI:1144388950
Name:DOPP, JASON C (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:DOPP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5328
Mailing Address - Country:US
Mailing Address - Phone:269-327-7300
Mailing Address - Fax:269-327-7331
Practice Address - Street 1:1616 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5328
Practice Address - Country:US
Practice Address - Phone:269-327-7300
Practice Address - Fax:269-327-7331
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist