Active NPI
Jason Aaron Dewitt, D.D.S.
- Oral and Maxillofacial Surgery (Dentist)
- Lafayette, IN
National Provider Identifier
1447371984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 12010545A
- Practice address
- 2204 Scott St
Lafayette, IN 47904-2933 - Phone
- (765) 447-0525
- Fax
- (765) 447-5815
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 12010545A | IN | Primary |
Addresses
Primary practice location
2204 Scott St
Lafayette, IN 47904-2933
Mailing address
2204 Scott St
Lafayette, IN 47904-2933
Phone (765) 447-0525
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12010545A | Other | IN | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2023 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285632000000",
"number": "1447371984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2204 SCOTT ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042933",
"telephone_number": "765-447-0525",
"fax_number": "765-447-5815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2204 SCOTT ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042933",
"telephone_number": "765-447-0525",
"fax_number": "765-447-5815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWITT",
"first_name": "JASON",
"middle_name": "AARON",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2010-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "IN",
"license": "12010545A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "12010545A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.