Provider Demographics
NPI:1730793118
Name:BHOGAL, JASKARAN SINGH (DMD)
Entity type:Individual
Prefix:
First Name:JASKARAN
Middle Name:SINGH
Last Name:BHOGAL
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 1:1819 W DUNLAP AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4375
Mailing Address - Country:US
Mailing Address - Phone:602-861-3333
Mailing Address - Fax:
Practice Address - Street 1:1819 W DUNLAP AVE STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4375
Practice Address - Country:US
Practice Address - Phone:602-861-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010742122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist