Healthcare Provider Details

I. General information

NPI: 1295644995
Provider Name (Legal Business Name): JASMINE G DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11450 4TH ST STE 102
RANCHO CUCAMONGA CA
91730-9024
US

IV. Provider business mailing address

11450 4TH ST STE 102
RANCHO CUCAMONGA CA
91730-9024
US

V. Phone/Fax

Practice location:
  • Phone: 909-244-0933
  • Fax:
Mailing address:
  • Phone: 909-244-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASMINE GILL
Title or Position: CEO
Credential: DDS
Phone: 909-244-0933