Provider Demographics
NPI:1194941690
Name:JASKULSKI, ALFRED STEPHEN (DMD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:STEPHEN
Last Name:JASKULSKI
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 1:32 E TIOGA ST
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-1506
Mailing Address - Country:US
Mailing Address - Phone:570-836-6975
Mailing Address - Fax:570-836-0716
Practice Address - Street 1:32 E TIOGA ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1506
Practice Address - Country:US
Practice Address - Phone:570-836-6975
Practice Address - Fax:570-836-0716
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029083L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist