Provider Demographics
NPI:1730521089
Name:SAIN, JASON R
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:SAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3732
Mailing Address - Country:US
Mailing Address - Phone:828-464-0064
Mailing Address - Fax:
Practice Address - Street 1:430 W 20TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3732
Practice Address - Country:US
Practice Address - Phone:828-464-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902RWMedicaid
NC902RWOtherNC HEALTHCHOICE
NC89902RWMedicaid