Provider Demographics
NPI:1760938054
Name:UMBACH, JASON (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:UMBACH
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLUGPLATZ ERBENHEIM 1040
Mailing Address - Street 2:
Mailing Address - City:WIESBADEN
Mailing Address - State:GERMANY
Mailing Address - Zip Code:65205
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FLUGPLATZ ERBENHEIM 1040
Practice Address - Street 2:
Practice Address - City:WIESBADEN
Practice Address - State:GERMANY
Practice Address - Zip Code:65205
Practice Address - Country:DE
Practice Address - Phone:314-590-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.24842122300000X
OH30.0248421223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentist