Provider Demographics
NPI:1225702020
Name:KUNDLAS, JASLEEN (DMD)
Entity Type:Individual
Prefix:
First Name:JASLEEN
Middle Name:
Last Name:KUNDLAS
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 1:1434 HADLEY CIR UNIT 213
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-8223
Mailing Address - Country:US
Mailing Address - Phone:607-377-2645
Mailing Address - Fax:
Practice Address - Street 1:1209 N RETAIL CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-9626
Practice Address - Country:US
Practice Address - Phone:843-874-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417625122300000X
SCDGD103311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist