Provider Demographics
NPI:1144367392
Name:SASEK, JAMIE J
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:J
Last Name:SASEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 W INA RD
Mailing Address - Street 2:APT. #8208
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2160
Mailing Address - Country:US
Mailing Address - Phone:520-293-0590
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:3922 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3276
Practice Address - Country:US
Practice Address - Phone:520-293-0590
Practice Address - Fax:520-293-0607
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD6897Medicaid