Provider Demographics
NPI:1316046725
Name:DUPREE, JASON I (DDS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:I
Last Name:DUPREE
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 1:1945 E. 70TH STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105
Mailing Address - Country:US
Mailing Address - Phone:318-797-1187
Mailing Address - Fax:318-797-1164
Practice Address - Street 1:1945 E. 70TH STREET
Practice Address - Street 2:SUITE F
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-797-1187
Practice Address - Fax:318-797-1164
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4874122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist