Provider Demographics
NPI:1043413172
Name:YASSICK, JAMES M (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:YASSICK
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 1:13012 OLD GLENN HWY
Mailing Address - Street 2:SUITE #102
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7561
Mailing Address - Country:US
Mailing Address - Phone:907-688-3388
Mailing Address - Fax:907-694-2451
Practice Address - Street 1:13012 OLD GLENN HWY
Practice Address - Street 2:SUITE #102
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7561
Practice Address - Country:US
Practice Address - Phone:907-694-2409
Practice Address - Fax:907-694-2451
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist