=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326889221
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANELLE MARIE NASSAR DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2024
-----------------------------------------------------
Last Update Date | 06/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1685 CROWN AVE
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17601-6322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-481-7645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 355 RIVERSIDE DR
-----------------------------------------------------
City | PORT REPUBLIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08241-9780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-214-9613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS044661
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------