Healthcare Provider Details

I. General information

NPI: 1538416912
Provider Name (Legal Business Name): JASON GORDON NATAUPSKY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 PIERCE ST SUITE 201
KINGSTON PA
18704-5700
US

IV. Provider business mailing address

575 PIERCE ST SUITE 201
KINGSTON PA
18704-5700
US

V. Phone/Fax

Practice location:
  • Phone: 570-331-8100
  • Fax:
Mailing address:
  • Phone: 570-331-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS039105
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02510100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: