Provider Demographics
NPI:1568967784
Name:JOHAL, BISHAL SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BISHAL
Middle Name:SINGH
Last Name:JOHAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST RM D-508
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-7001
Mailing Address - Country:US
Mailing Address - Phone:859-257-2002
Mailing Address - Fax:859-323-5858
Practice Address - Street 1:800 ROSE ST RM D-508
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-257-2002
Practice Address - Fax:859-323-5858
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery