Provider Demographics
NPI:1053534164
Name:DERR, JASON MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:DERR
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 1:2535 FM 1960 RD E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-2505
Mailing Address - Country:US
Mailing Address - Phone:281-443-7524
Mailing Address - Fax:
Practice Address - Street 1:2535 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-2505
Practice Address - Country:US
Practice Address - Phone:281-443-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19534122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist