Provider Demographics
NPI:1538320890
Name:JASON E. SUDATI, DMD, PC
Entity Type:Organization
Organization Name:JASON E. SUDATI, DMD, PC
Other - Org Name:AMOSKEAG FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUDATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-627-1301
Mailing Address - Street 1:316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-4842
Mailing Address - Country:US
Mailing Address - Phone:603-627-1301
Mailing Address - Fax:
Practice Address - Street 1:316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4842
Practice Address - Country:US
Practice Address - Phone:603-627-1301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03648261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental