Provider Demographics
NPI:1497868616
Name:JASAM, PC
Entity Type:Organization
Organization Name:JASAM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAMIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-947-6606
Mailing Address - Street 1:47 E GROVE ST
Mailing Address - Street 2:STE 204
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1816
Mailing Address - Country:US
Mailing Address - Phone:508-947-6606
Mailing Address - Fax:508-947-7660
Practice Address - Street 1:47 E GROVE ST
Practice Address - Street 2:STE 204
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1816
Practice Address - Country:US
Practice Address - Phone:508-947-6606
Practice Address - Fax:508-947-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11823OtherBLUE CROSS
MA6690790001Medicare NSC