Provider Demographics
NPI:1386058501
Name:WEBER, JASON A
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:WEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 SW WANAMAKER DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4116
Mailing Address - Country:US
Mailing Address - Phone:785-273-2922
Mailing Address - Fax:785-272-1404
Practice Address - Street 1:2930 SW WANAMAKER DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4116
Practice Address - Country:US
Practice Address - Phone:785-273-2922
Practice Address - Fax:785-272-1404
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140187491223G0001X
KS61122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice