Healthcare Provider Details

I. General information

NPI: 1053806448
Provider Name (Legal Business Name): JASMINE GEAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DISTILLERY RD STE 200
WESTMINSTER MD
21157-5344
US

IV. Provider business mailing address

4133 DAYLILY DR
OWINGS MILLS MD
21117-5034
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-1478
  • Fax:
Mailing address:
  • Phone: 443-416-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858360
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17242
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: