Provider Demographics
NPI:1366926792
Name:SASINE, JOHN KEITH
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KEITH
Last Name:SASINE
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 1:2207 COYOTE CREST VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7202
Mailing Address - Country:US
Mailing Address - Phone:801-835-8632
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAL HEALTH ACTIVITY HAWAII
Practice Address - Street 2:1 JARRETT WHITE ROAD, MCDS-NH
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5000
Practice Address - Country:US
Practice Address - Phone:808-438-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10880891-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist