Provider Demographics
NPI:1063435048
Name:JASSAL, RAMAN K (DDS)
Entity type:Individual
Prefix:DR
First Name:RAMAN
Middle Name:K
Last Name:JASSAL
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 1:112 ELDEN ST
Mailing Address - Street 2:SUITE #N
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4874
Mailing Address - Country:US
Mailing Address - Phone:703-787-9000
Mailing Address - Fax:703-787-9000
Practice Address - Street 1:112 ELDEN ST
Practice Address - Street 2:SUITE #N
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4874
Practice Address - Country:US
Practice Address - Phone:703-787-9000
Practice Address - Fax:703-787-9000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010067111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice