Provider Demographics
NPI:1023362803
Name:SAPP, ROSS JAGGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:JAGGER
Last Name:SAPP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LILLY RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6101
Mailing Address - Country:US
Mailing Address - Phone:360-459-9657
Mailing Address - Fax:
Practice Address - Street 1:220 LILLY RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-459-9657
Practice Address - Fax:360-459-9652
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60314803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist