Provider Demographics
NPI:1861562894
Name:TROUTMAN, S JASON (DDS)
Entity type:Individual
Prefix:DR
First Name:S
Middle Name:JASON
Last Name:TROUTMAN
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 1:200 MEBANE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9643
Mailing Address - Country:US
Mailing Address - Phone:919-563-5939
Mailing Address - Fax:919-563-6676
Practice Address - Street 1:200 MEBANE OAKS RD
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9643
Practice Address - Country:US
Practice Address - Phone:919-563-5939
Practice Address - Fax:919-563-6676
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1875029Medicare UPIN