Basic Information
| Provider Information | |||||||||
| NPI: | 1114532082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GINSBURG | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 KERWIN RD APT 600 | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441183954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106138333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4071 LEE RD STE 260 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441282173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167270234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2020 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | RES.004294 | OH | Y | Dental Providers | Dentist | General Practice |
No ID Information.