Provider Demographics
NPI:1407942469
Name:SASPORTAS, JONATHON S (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:S
Last Name:SASPORTAS
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 WHITEHORSE MERCERVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1994
Mailing Address - Country:US
Mailing Address - Phone:609-587-2900
Mailing Address - Fax:609-587-1749
Practice Address - Street 1:2303 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:OMSCNJ
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1931
Practice Address - Country:US
Practice Address - Phone:609-587-2900
Practice Address - Fax:609-587-1749
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018402021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T70204Medicare UPIN
NJ007049ABKMedicare ID - Type Unspecified