Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1457088965 Deactivated / Inactive NPI Male Practitioner

Jason John Tupper , BDS

Dentist - General Practice • Edwardsville, IL

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Jason Tupper has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 04, 2022
NPI Deactivation Date March 13, 2023
Total Practice Duration ~1 Years of Practice (2022 – 2023)

Professional Overview & Biography Verified Profile Summary

Jason Tupper, BDS was a registered Dentist - General Practice practicing in Edwardsville, IL. Throughout an active medical career spanning 1 years, Jason Tupper provided care at the practice location at 600 COUNTRY CLUB VW STE 4 until profile deactivation on 2023-03-13.

Practice Location & Contact Primary Location

Practice Address

600 Country Club Vw Ste 4

Edwardsville, IL 620253638

Telephone 6183073267
Associated Practice Facility / Clinic
🏢 Harvey H Breckner D.m.d.,m.s Facility NPI 1447415757

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Edwardsville, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
12 Specialists

Practicing in Edwardsville, IL (5581 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-10-22
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MO 2025011907

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Dentist - Prosthodontics

NUCC Taxonomy Code: 1223P0700X

State License IL 019.036573

That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes.

Secondary Practice Locations

University Of Tennessee Health Science Centre, 875 Union Ave Dunn Building,

Memphis, TN 38103

Phone: 9014486468

1 Westbury Dr Ste 310

Saint Charles, MO 633012560

Phone: 6367236071

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Harvey Breckner , DMD, MS

Dentist - Prosthodontics

NPI 1962663245

Doctor of Dental Medicine, Master of Science

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

14 Historical Events
📍
Updated Practice Location October 22, 2025

Registered at 600 COUNTRY CLUB VW STE 4, EDWARDSVILLE, IL 620253638 (Tel: 6183073267)

📍
Updated Business Mailing Address October 22, 2025

Registered at 4101 LACLEDE AVE UNIT 211, SAINT LOUIS, MO 631082998

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 22, 2025

Dentist (License #2025011907 in MO)

📍
Updated Practice Location November 28, 2023

Registered at UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTRE, 875 UNION AVE DUNN BUILDING,, MEMPHIS, TN 38103 (Tel: 9014486468)

📍
Updated Business Mailing Address November 28, 2023

Registered at 395 SOUTH HIGHLAND STREET, MEMPHIS, TN 38111

👤
Provider Name / Credentials Updated November 28, 2023

Recorded as JASON TUPPER, BDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 28, 2023

Student in an Organized Health Care Education/Training Program

⚠️
NPI Profile Deactivated March 13, 2023

Record deactivated on March 13, 2023

NPI Profile Active August 04, 2022

NPI status registered as active in NPPES database

📍
Updated Practice Location August 04, 2022

Registered at UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTRE, 875 UNION AVE DUNN BUILDING,, MEMPHIS, TN 38103 (Tel: 9014486468)

📍
Updated Business Mailing Address August 04, 2022

Registered at 395 SOUTH HIGHLAND STREET, MEMPHIS, TN 38111

👤
Provider Name / Credentials Updated August 04, 2022

Recorded as JASON TUPPER, BDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 04, 2022

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration August 04, 2022

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Jason Tupper. Be the first to share your experience!

Sign in to leave a review for Jason Tupper

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1457088965
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 04, 2022
Last Update: October 22, 2025
Deactivation Date: March 13, 2023
Sole Proprietor: Yes

Mailing Address

4101 Laclede Ave Unit 211

Saint Louis, MO 631082998

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.