Provider Demographics
NPI:1265016380
Name:DASSAH, MARCUS (DMD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:DASSAH
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 1:5424 ROCK MERRITT AVENUE
Mailing Address - Street 2:
Mailing Address - City:POPE FIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28308-5064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5424 ROCK MERRITT AVENUE
Practice Address - Street 2:
Practice Address - City:POPE FIELD
Practice Address - State:NC
Practice Address - Zip Code:28308-5529
Practice Address - Country:US
Practice Address - Phone:937-257-8761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0265741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice