Provider Demographics
NPI:1053753319
Name:ROEDIG, JASON JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOSEPH
Last Name:ROEDIG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5073 MAIN ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2737
Mailing Address - Country:US
Mailing Address - Phone:615-302-4200
Mailing Address - Fax:615-302-4201
Practice Address - Street 1:5073 MAIN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2737
Practice Address - Country:US
Practice Address - Phone:615-302-4200
Practice Address - Fax:615-302-4201
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000096311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics