Provider Demographics
NPI:1871752352
Name:LEMMON, JASON THOMAS (DDS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:THOMAS
Last Name:LEMMON
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 1:3325 S. AVE 8E
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365
Mailing Address - Country:US
Mailing Address - Phone:928-344-3177
Mailing Address - Fax:928-344-3157
Practice Address - Street 1:3325 S. AVE 8E
Practice Address - Street 2:SUITE 4
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365
Practice Address - Country:US
Practice Address - Phone:928-344-3177
Practice Address - Fax:928-344-3157
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23451122300000X
AZ7490122300000X
AZAZ7490122300000X
TXTX23451122300000X
CACA59150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist