Provider Demographics
NPI:1114532082
Name:GINSBURG, JASON (DMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GINSBURG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 KERWIN RD APT 600
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3954
Mailing Address - Country:US
Mailing Address - Phone:610-613-8333
Mailing Address - Fax:
Practice Address - Street 1:4071 LEE RD STE 260
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2173
Practice Address - Country:US
Practice Address - Phone:216-727-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0042941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice