Provider Demographics
NPI:1295150688
Name:JASMEEN GOYAL CORP
Entity type:Organization
Organization Name:JASMEEN GOYAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-710-6203
Mailing Address - Street 1:2830 N BEACH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76111-6246
Mailing Address - Country:US
Mailing Address - Phone:817-710-6203
Mailing Address - Fax:
Practice Address - Street 1:2830 N BEACH ST
Practice Address - Street 2:SUITE H
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76111-6246
Practice Address - Country:US
Practice Address - Phone:817-710-6203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-22
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty