Provider Demographics
NPI:1164911855
Name:DHANJAL, JASMIN KAUR (DDS)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:KAUR
Last Name:DHANJAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-2053
Mailing Address - Country:US
Mailing Address - Phone:417-932-1000
Mailing Address - Fax:
Practice Address - Street 1:1535 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-2053
Practice Address - Country:US
Practice Address - Phone:317-932-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013135A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice