Healthcare Provider Details

I. General information

NPI: 1326369133
Provider Name (Legal Business Name): JONATHAN SCHUBERT D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 07/09/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP UNIT 5268, KADENA AIR BASE,
APO AP
96368-5142
US

IV. Provider business mailing address

18 MDG OPC 80 BOX 5217
APO AP
96368
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4817
  • Fax:
Mailing address:
  • Phone: 315-630-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS044153
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10202
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: