Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS0000009631 | TN |
NPI | 1053753319 |
---|---|
Provider Name | Dr. Jason Joseph Roedig |
First Address | Spring Hill, TN 37174-2737 |
Second Address | Spring Hill, TN 37174-2737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2013 |
Last Update Date | 26/07/2013 |