Provider Demographics
NPI:1881079507
Name:SASTIEL, SHANNE JONATHAN (DDS)
Entity type:Individual
Prefix:
First Name:SHANNE
Middle Name:JONATHAN
Last Name:SASTIEL
Suffix:
Gender:M
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:BOX 0762, 707 PARNASSUS AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:818-588-1802
Mailing Address - Fax:
Practice Address - Street 1:707 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0762
Practice Address - Country:US
Practice Address - Phone:818-588-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics