Provider Demographics
NPI:1720135403
Name:JOHL, JASDEEP (DDS)
Entity type:Individual
Prefix:
First Name:JASDEEP
Middle Name:
Last Name:JOHL
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 1:100 CORTONA WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513
Mailing Address - Country:US
Mailing Address - Phone:925-513-7333
Mailing Address - Fax:925-513-7557
Practice Address - Street 1:100 CORTONA WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513
Practice Address - Country:US
Practice Address - Phone:925-513-7333
Practice Address - Fax:925-513-7557
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52404122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice