Provider Demographics
NPI:1518382506
Name:STREVER, JASON (DMD, MS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:STREVER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 OLD GODSEY LN STE 1
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-6604
Mailing Address - Country:US
Mailing Address - Phone:423-870-9567
Mailing Address - Fax:
Practice Address - Street 1:5022 OLD GODSEY LN STE 1
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6604
Practice Address - Country:US
Practice Address - Phone:423-870-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics