Healthcare Provider Details

I. General information

NPI: 1790900199
Provider Name (Legal Business Name): JASLEEN BRAR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 IRVINE BLVD STE 205
TUSTIN CA
92780-3402
US

IV. Provider business mailing address

18102 IRVINE BLVD STE 205
TUSTIN CA
92780
US

V. Phone/Fax

Practice location:
  • Phone: 714-731-5656
  • Fax: 714-731-2607
Mailing address:
  • Phone: 714-731-5656
  • Fax: 714-731-2607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number43903
License Number StateCA

VIII. Authorized Official

Name: DR. JASLEEN BRAR
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-731-5656