Healthcare Provider Details
I. General information
NPI: 1467425157
Provider Name (Legal Business Name): DRS. JOHAL, DUNNING & ASSOCIATES II, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/11/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7510 PINEVILLE MATTHEWS RD
CHARLOTTE NC
28226-3906
US
IV. Provider business mailing address
PO BOX 860036
MINNEAPOLIS MN
55486-0036
US
V. Phone/Fax
- Phone: 704-544-0965
- Fax: 216-584-1106
- Phone: 704-544-0965
- Fax: 216-584-1106
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 122300000X |
| Taxonomy | Dentist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223E0200X |
| Taxonomy | Endodontics |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223P0221X |
| Taxonomy | Pediatric Dentistry |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223P0300X |
| Taxonomy | Periodontics |
| License Number | |
| License Number State | |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223P0700X |
| Taxonomy | Prosthodontics |
| License Number | |
| License Number State | |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223S0112X |
| Taxonomy | Oral and Maxillofacial Surgery (Dentist) |
| License Number | |
| License Number State | |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1223X0400X |
| Taxonomy | Orthodontics and Dentofacial Orthopedics Dentistry |
| License Number | |
| License Number State | |
| # 8 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1223G0001X |
| Taxonomy | General Practice Dentistry |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MRS.
JOTINDER
K.
JOHAL
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 704-544-0965