Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019027948 | IL |
Y | 1223X0400X | Orthodontists | 19561 | FL |
NPI | 1073740114 |
---|---|
Provider Name | Dr. Jasleen Kaur Raina |
First Address | Fort Myers, FL 33913-8808 |
Second Address | Jacksonville Beach, FL 32250-5602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 11/06/2019 |