Provider Demographics
NPI:1902210503
Name:JASSAL, KULBIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KULBIR
Middle Name:
Last Name:JASSAL
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 1:4094 LEDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4318
Mailing Address - Country:US
Mailing Address - Phone:248-633-4187
Mailing Address - Fax:
Practice Address - Street 1:1755 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3510
Practice Address - Country:US
Practice Address - Phone:248-643-7530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010212611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice