Provider Demographics
NPI:1114228707
Name:SASSANO, DANIEL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:SASSANO
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 1:704 S SUTHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5065
Mailing Address - Country:US
Mailing Address - Phone:704-289-9519
Mailing Address - Fax:704-225-1969
Practice Address - Street 1:704 S SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5065
Practice Address - Country:US
Practice Address - Phone:704-289-9519
Practice Address - Fax:704-225-1969
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997580Medicaid