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General NPI Number Information
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NPI Number | 1144049354
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Entity Type | Organization
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Legal Business Name | JAS GURAM, DMD, LLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 1562 CONSTITUTION BLVD STE 102
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City | ROCK HILL
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State | SC
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Zip | 29732-3540
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Country | US
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Telephone | 803-328-8865
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Fax |
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Provider Business Mailing Address
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Address Line | 5160 LONGBROOKE CT
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City | INDIAN LAND
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State | SC
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Zip | 29707-8738
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. JASDEEP SINGH GURAM
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Credential | DMD
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Telephone | 803-760-9947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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