Provider Demographics
NPI:1063827632
Name:PATHIYIL, JASMIN CLARA (DMD)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:CLARA
Last Name:PATHIYIL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SOUTHPOINT LOOP
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8899
Mailing Address - Country:US
Mailing Address - Phone:281-414-5474
Mailing Address - Fax:
Practice Address - Street 1:117 SOUTHPOINT LOOP
Practice Address - Street 2:SUITE 400
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8899
Practice Address - Country:US
Practice Address - Phone:281-414-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice