Provider Demographics
NPI:1033854237
Name:JASWAL, ACHMAN SINGH
Entity Type:Individual
Prefix:
First Name:ACHMAN
Middle Name:SINGH
Last Name:JASWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 S ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-6525
Mailing Address - Country:US
Mailing Address - Phone:206-619-1155
Mailing Address - Fax:
Practice Address - Street 1:1804 19TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6707
Practice Address - Country:US
Practice Address - Phone:916-246-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist