Provider Demographics
NPI:1477655009
Name:BIRNBAUM, JASON (DDS,FAGD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:DDS,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1518
Mailing Address - Country:US
Mailing Address - Phone:908-859-2600
Mailing Address - Fax:
Practice Address - Street 1:210 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1518
Practice Address - Country:US
Practice Address - Phone:908-859-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI014913001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice