Provider Demographics
NPI:1447373501
Name:SASALA, ALBERT T (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:T
Last Name:SASALA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9856 LORI RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6623
Mailing Address - Country:US
Mailing Address - Phone:804-717-1100
Mailing Address - Fax:804-717-2174
Practice Address - Street 1:9856 LORI RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6623
Practice Address - Country:US
Practice Address - Phone:804-717-1100
Practice Address - Fax:804-717-2174
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist