Healthcare Provider Details

I. General information

NPI: 1386058501
Provider Name (Legal Business Name): JASON A WEBER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 SW WANAMAKER DR
TOPEKA KS
66614-4116
US

IV. Provider business mailing address

2930 SW WANAMAKER DR
TOPEKA KS
66614-4116
US

V. Phone/Fax

Practice location:
  • Phone: 785-273-2922
  • Fax: 785-272-1404
Mailing address:
  • Phone: 785-273-2922
  • Fax: 785-272-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number61122
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2014018749
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: