Provider Demographics
NPI:1639832892
Name:JASBIR CHEEMA DENTAL CORPORATION
Entity Type:Organization
Organization Name:JASBIR CHEEMA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-323-9334
Mailing Address - Street 1:4565 QUAIL LAKES DR STE A2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5294
Mailing Address - Country:US
Mailing Address - Phone:209-926-0390
Mailing Address - Fax:
Practice Address - Street 1:4565 QUAIL LAKES DR STE A2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5294
Practice Address - Country:US
Practice Address - Phone:209-926-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty