Provider Demographics
NPI:1952530131
Name:ANTHONY, JASSEN ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASSEN
Middle Name:ALLEN
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 HIGHWAY 67 S
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-6300
Mailing Address - Country:US
Mailing Address - Phone:256-355-0199
Mailing Address - Fax:
Practice Address - Street 1:466 HIGHWAY 67 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-6300
Practice Address - Country:US
Practice Address - Phone:256-355-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice