Provider Demographics
NPI:1558579904
Name:J. R. GASSMAN, D.D.S., INC.
Entity Type:Organization
Organization Name:J. R. GASSMAN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:OLSON
Authorized Official - Last Name:GASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-440-7007
Mailing Address - Street 1:402 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5209
Mailing Address - Country:US
Mailing Address - Phone:619-440-7007
Mailing Address - Fax:619-440-7231
Practice Address - Street 1:402 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5209
Practice Address - Country:US
Practice Address - Phone:619-440-7007
Practice Address - Fax:619-440-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932285269OtherTYPE I