Provider Demographics
NPI:1013238716
Name:SASEK, JEANINE (DDS)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:SASEK
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 1:1700 E POINTE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6987
Mailing Address - Country:US
Mailing Address - Phone:573-443-1525
Mailing Address - Fax:573-875-4834
Practice Address - Street 1:1700 E POINTE DR STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6987
Practice Address - Country:US
Practice Address - Phone:573-443-1525
Practice Address - Fax:573-875-4834
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist