Provider Demographics
NPI:1316045149
Name:JASKOLSKI, JEFFREY M (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:JASKOLSKI
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 1:22151 MOROSS RD
Mailing Address - Street 2:SUITE G34
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2167
Mailing Address - Country:US
Mailing Address - Phone:313-882-4970
Mailing Address - Fax:313-882-3654
Practice Address - Street 1:22151 MOROSS RD
Practice Address - Street 2:SUITE G34
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2167
Practice Address - Country:US
Practice Address - Phone:313-882-4970
Practice Address - Fax:313-882-3654
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI014224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist