Provider Demographics
NPI:1952819369
Name:JARED P. SASS D.D.S PLC
Entity Type:Organization
Organization Name:JARED P. SASS D.D.S PLC
Other - Org Name:WEST LAKES FAMILY DENTISTRY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SASS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-225-2424
Mailing Address - Street 1:6800 LAKE DR STE 290
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2544
Mailing Address - Country:US
Mailing Address - Phone:515-225-2424
Mailing Address - Fax:515-225-2313
Practice Address - Street 1:6800 LAKE DR STE 290
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2544
Practice Address - Country:US
Practice Address - Phone:515-225-2424
Practice Address - Fax:515-225-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09213261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental