MEDICARE: JHEETEY DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1487316477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JHEETEY DENTAL PLLC

Provider Business Mailing Address
First Line	:	2200 N A W GRIMES BLVD STE 100
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N A W GRIMES BLVD STE 100
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2424
Country	:	US
Telephone Number	:	512-609-0066
Fax Number	:

Authorized Official
Title or Position	:	DENTISIT
Name	:	RAVNEET KAUR
Credential	:
Telephone Number	:	734-262-0404

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	10/07/2021

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