Provider Demographics
NPI:1790900199
Name:JASLEEN BRAR DDS INC
Entity Type:Organization
Organization Name:JASLEEN BRAR DDS INC
Other - Org Name:A A FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-731-5656
Mailing Address - Street 1:18102 IRVINE BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-731-5656
Mailing Address - Fax:714-731-2607
Practice Address - Street 1:18102 IRVINE BLVD
Practice Address - Street 2:STE 205
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3402
Practice Address - Country:US
Practice Address - Phone:714-731-5656
Practice Address - Fax:714-731-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty