Provider Demographics
NPI:1154405181
Name:JASON WASSERMAN, D.M.D.,P.A.
Entity type:Organization
Organization Name:JASON WASSERMAN, D.M.D.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:H
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-541-5454
Mailing Address - Street 1:125 LINCOLN AVE
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-2738
Mailing Address - Country:US
Mailing Address - Phone:732-541-5454
Mailing Address - Fax:
Practice Address - Street 1:125 LINCOLN AVE
Practice Address - Street 2:FLOOR 1
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-2738
Practice Address - Country:US
Practice Address - Phone:732-541-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02229500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty