Provider Demographics
NPI:1174807986
Name:BENEPAL, JASLEEN KAUR (DDS)
Entity type:Individual
Prefix:
First Name:JASLEEN
Middle Name:KAUR
Last Name:BENEPAL
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 1:161 S. 2ND STREET
Mailing Address - Street 2:CANALVIEW DENTAL ASSOCIATES
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069
Mailing Address - Country:US
Mailing Address - Phone:315-593-2506
Mailing Address - Fax:315-593-1896
Practice Address - Street 1:161 S 2ND ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1723
Practice Address - Country:US
Practice Address - Phone:315-593-2506
Practice Address - Fax:315-593-1896
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000105-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice