Provider Demographics
NPI:1447414875
Name:GOYAL, JASMEEN (DDS)
Entity type:Individual
Prefix:
First Name:JASMEEN
Middle Name:
Last Name:GOYAL
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 1:2830 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:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26273122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist