Provider Demographics
NPI:1518022128
Name:GASSER, JEFFREY L (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:GASSER
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:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:WI
Mailing Address - Zip Code:54112-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 BUSINESS 141 N
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:WI
Practice Address - Zip Code:54112
Practice Address - Country:US
Practice Address - Phone:920-897-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice