Provider Demographics
NPI:1386010866
Name:JASSAR, SUKHMANI (BDS, MS)
Entity Type:Individual
Prefix:
First Name:SUKHMANI
Middle Name:
Last Name:JASSAR
Suffix:
Gender:F
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BROADWAY ST
Mailing Address - Street 2:APT 508
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3321
Mailing Address - Country:US
Mailing Address - Phone:323-241-7761
Mailing Address - Fax:
Practice Address - Street 1:500 BROADWAY ST
Practice Address - Street 2:APT 508
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3321
Practice Address - Country:US
Practice Address - Phone:323-241-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313901223P0221X
WA60684370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry