Provider Demographics
NPI:1770100976
Name:JAGDEEP DHALL, D.M.D., P.A.
Entity type:Organization
Organization Name:JAGDEEP DHALL, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:DHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-840-5066
Mailing Address - Street 1:430 WAYMONT CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6745
Mailing Address - Country:US
Mailing Address - Phone:407-322-1688
Mailing Address - Fax:407-322-1684
Practice Address - Street 1:430 WAYMONT CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6745
Practice Address - Country:US
Practice Address - Phone:407-322-1688
Practice Address - Fax:407-322-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental