Provider Demographics
NPI:1124165741
Name:DEOL, JASKIRAN K (DDS)
Entity type:Individual
Prefix:DR
First Name:JASKIRAN
Middle Name:K
Last Name:DEOL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2123
Mailing Address - Country:US
Mailing Address - Phone:702-870-3818
Mailing Address - Fax:702-258-7649
Practice Address - Street 1:2421 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2123
Practice Address - Country:US
Practice Address - Phone:702-870-3818
Practice Address - Fax:702-258-7649
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV41621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice