Provider Demographics
NPI:1134640683
Name:NASSAR, DOROTHY S (DMD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:S
Last Name:NASSAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 PARKER DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1942
Mailing Address - Country:US
Mailing Address - Phone:601-649-3335
Mailing Address - Fax:601-426-6318
Practice Address - Street 1:1434 PARKER DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1942
Practice Address - Country:US
Practice Address - Phone:601-649-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3947-17122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist