Provider Demographics
NPI:1245373216
Name:LEHMAN, JASON THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:THOMAS
Last Name:LEHMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6615
Mailing Address - Country:US
Mailing Address - Phone:707-544-1836
Mailing Address - Fax:707-542-0617
Practice Address - Street 1:80 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6615
Practice Address - Country:US
Practice Address - Phone:707-544-1836
Practice Address - Fax:707-542-0617
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice