Healthcare Provider Details

I. General information

NPI: 1801808845
Provider Name (Legal Business Name): JOHAL MEDICAL ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PARSON PL
COLONIA NJ
07067-2704
US

IV. Provider business mailing address

16 PARSON PL
COLONIA NJ
07067-2704
US

V. Phone/Fax

Practice location:
  • Phone: 732-634-5600
  • Fax: 732-634-5692
Mailing address:
  • Phone: 732-634-5600
  • Fax: 732-634-5692

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: DR. SUNDEEP CHAHAL JOHAL
Title or Position: DENTAST
Credential: D.D.S
Phone: 732-634-5600