Healthcare Provider Details

I. General information

NPI: 1356061923
Provider Name (Legal Business Name): JASON GOPAUL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HUGHES DR
TOLEDO OH
43606-3858
US

IV. Provider business mailing address

2109 HUGHES DR
TOLEDO OH
43606-3858
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-4000
  • Fax:
Mailing address:
  • Phone: 419-291-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD5373
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: