Provider Demographics
NPI:1881052272
Name:SARIC, JASMINA (DMD)
Entity type:Individual
Prefix:
First Name:JASMINA
Middle Name:
Last Name:SARIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3409
Mailing Address - Country:US
Mailing Address - Phone:440-240-1655
Mailing Address - Fax:440-240-1655
Practice Address - Street 1:1205 BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3409
Practice Address - Country:US
Practice Address - Phone:440-240-1655
Practice Address - Fax:440-240-1655
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0315145Medicaid