Provider Demographics
NPI:1871596734
Name:SPEIGEL, JASON RYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:RYAN
Last Name:SPEIGEL
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 1:110 S WOODLAND ST
Mailing Address - Street 2:APT 101
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:409-905-8827
Mailing Address - Fax:407-905-8980
Practice Address - Street 1:209 E 7TH ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5327
Practice Address - Country:US
Practice Address - Phone:407-886-9569
Practice Address - Fax:407-886-9569
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN170271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice