Provider Demographics
NPI:1538416912
Name:NATAUPSKY, JASON GORDON (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:GORDON
Last Name:NATAUPSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 PIERCE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5700
Mailing Address - Country:US
Mailing Address - Phone:570-331-8100
Mailing Address - Fax:
Practice Address - Street 1:575 PIERCE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5700
Practice Address - Country:US
Practice Address - Phone:570-331-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025101001223G0001X
PADS039105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1225070048Medicaid