Healthcare Provider Details

I. General information

NPI: 1760938054
Provider Name (Legal Business Name): JASON UMBACH DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLUGPLATZ ERBENHEIM 1040
WIESBADEN GERMANY
65205
DE

IV. Provider business mailing address

FLUGPLATZ ERBENHEIM 1040
WIESBADEN GERMANY
65205
DE

V. Phone/Fax

Practice location:
  • Phone: 314-590-1515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.24842
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number30.024842
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: