=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982194445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GHUMAN DENTAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2018
-----------------------------------------------------
Last Update Date | 05/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3315 SHERWOOD WAY UNIT 117
-----------------------------------------------------
City | SAN ANGELO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76901-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-716-1555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3315 SHERWOOD WAY UNIT 117
-----------------------------------------------------
City | SAN ANGELO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76901-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. JASPREET SINGH GHUMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-793-6836
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------