Active NPI
Jason Donald Mecum, DHAT
- Dental Therapist
- Coos Bay, OR
National Provider Identifier
1508531666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Therapist
- License
- 18-TDT-02
- Practice address
- 630 Miluk Dr
Coos Bay, OR 97420-7728 - Phone
- (541) 888-9494
- NPI assigned
- Aug 11, 2021
- 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 |
|---|---|---|---|---|
| Dental Therapist | 125J00000X | 18-TDT-02 | WA | Primary |
Addresses
Primary practice location
630 Miluk Dr
Coos Bay, OR 97420-7728
Mailing address
PO Box 3190
Coos Bay, OR 97420-0407
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18-TDT-02 | WA | MD | Dental Therapist |
Interoperability endpoints
- jason.mecum.p2@direct.coquilletribe.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628640000000",
"number": "1508531666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3190",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974200407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 MILUK DR",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974207728",
"telephone_number": "541-888-9494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MECUM",
"first_name": "JASON",
"middle_name": "DONALD",
"name_prefix": "Mr.",
"credential": "DHAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-11",
"last_updated": "2021-08-11",
"certification_date": "2021-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "125J00000X",
"taxonomy_group": "",
"desc": "Dental Therapist",
"state": "WA",
"license": "18-TDT-02",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.