Provider Demographics
NPI:1770986036
Name:DASSOW, ALEXANDER (RD, CD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:DASSOW
Suffix:
Gender:M
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3440
Mailing Address - Country:US
Mailing Address - Phone:920-980-5439
Mailing Address - Fax:
Practice Address - Street 1:3003 BREEZEWOOD LN
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-9611
Practice Address - Country:US
Practice Address - Phone:920-722-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2776-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered