Provider Demographics
NPI:1497910517
Name:MCDONALD, JASON SEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:SEAN
Last Name:MCDONALD
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 1:3838 N VERSAILLES AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-5926
Mailing Address - Country:US
Mailing Address - Phone:312-532-9903
Mailing Address - Fax:
Practice Address - Street 1:18835 LBJ FWY STE A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6459
Practice Address - Country:US
Practice Address - Phone:972-619-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0277351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice