Provider Demographics
NPI:1902295918
Name:DASSO, EDWIN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:JOSEPH
Last Name:DASSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6491 PIPEWOOD CURV
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-7702
Mailing Address - Country:US
Mailing Address - Phone:336-255-8038
Mailing Address - Fax:
Practice Address - Street 1:6491 PIPEWOOD CURV
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-7702
Practice Address - Country:US
Practice Address - Phone:336-255-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4953207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology