Provider Demographics
NPI:1922584663
Name:JOHAL, PRITPAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRITPAL
Middle Name:
Last Name:JOHAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 DIAMOND MESA TRL SW APT 2703
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-3718
Mailing Address - Country:US
Mailing Address - Phone:209-765-4246
Mailing Address - Fax:
Practice Address - Street 1:3211 COORS BLVD SW STE D2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5255
Practice Address - Country:US
Practice Address - Phone:209-765-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6548122300000X
NMDD22006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist