Provider Demographics
NPI:1922656495
Name:DHERI, JASPREET
Entity Type:Individual
Prefix:
First Name:JASPREET
Middle Name:
Last Name:DHERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 COFFEE RD STE C4
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2413
Mailing Address - Country:US
Mailing Address - Phone:209-238-9444
Mailing Address - Fax:
Practice Address - Street 1:2030 COFFEE RD STE C4
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2413
Practice Address - Country:US
Practice Address - Phone:209-238-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27255124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist