Provider Demographics
NPI:1679152185
Name:ACOSTA-SASSOON, JOANNA MARIE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOANNA MARIE
Middle Name:S
Last Name:ACOSTA-SASSOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 EISENHOWER AVE UNIT 404
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7359
Mailing Address - Country:US
Mailing Address - Phone:703-646-1162
Mailing Address - Fax:
Practice Address - Street 1:4473 MARKET COMMONS DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-6033
Practice Address - Country:US
Practice Address - Phone:703-865-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-03
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172851223G0001X
VA04014166021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice