Provider Demographics
NPI:1952294381
Name:SASSACK, JASON ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:SASSACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JASE
Other - Middle Name:ROBERT
Other - Last Name:SASSACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:421 BENSON AVE NE APT 2113
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-0003
Mailing Address - Country:US
Mailing Address - Phone:734-775-4929
Mailing Address - Fax:
Practice Address - Street 1:933 3 MILE RD NW STE 110
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1673
Practice Address - Country:US
Practice Address - Phone:616-784-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist