Provider Demographics
NPI:1861586919
Name:S. JASON TROUTMAN D.D.S., PLLC
Entity type:Organization
Organization Name:S. JASON TROUTMAN D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:TROUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-563-5939
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1875029Medicare UPIN