Provider Demographics
NPI:1952445348
Name:SMITHBERGER, JASON RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RICHARD
Last Name:SMITHBERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 KENILWORTH DR STE 201
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2334
Mailing Address - Country:US
Mailing Address - Phone:410-583-9244
Mailing Address - Fax:410-583-9118
Practice Address - Street 1:658 KENILWORTH DR STE 201
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2334
Practice Address - Country:US
Practice Address - Phone:410-583-9244
Practice Address - Fax:410-583-9118
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice