Provider Demographics
NPI:1295873305
Name:WALIA, JASDEEP J (DDS)
Entity type:Individual
Prefix:DR
First Name:JASDEEP
Middle Name:J
Last Name:WALIA
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 1:800 N. INDUSTRIAL BLVD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-7497
Mailing Address - Country:US
Mailing Address - Phone:817-267-5362
Mailing Address - Fax:817-283-6309
Practice Address - Street 1:800 N INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-7400
Practice Address - Country:US
Practice Address - Phone:817-267-5362
Practice Address - Fax:817-283-6309
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice