Provider Demographics
NPI:1114109386
Name:JOHAL AND GHAZAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:JOHAL AND GHAZAL DENTAL CORPORATION
Other - Org Name:ELK GROVE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTS ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:INAKSH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-686-9030
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:9640 BRUCEVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5950
Practice Address - Country:US
Practice Address - Phone:916-686-9030
Practice Address - Fax:916-686-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty