Provider Demographics
NPI:1730200684
Name:PUJO, JASON PETER (DMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PETER
Last Name:PUJO
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 1:1141 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4738
Mailing Address - Country:US
Mailing Address - Phone:978-957-1898
Mailing Address - Fax:978-957-6262
Practice Address - Street 1:1141 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4738
Practice Address - Country:US
Practice Address - Phone:978-957-1898
Practice Address - Fax:978-957-6262
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice