Healthcare Provider Details

I. General information

NPI: 1619177631
Provider Name (Legal Business Name): PREET KHERA SAHOTA D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39572 STEVENSON PLACE SUITE #131
FREMONT CA
94539
US

IV. Provider business mailing address

39572 STEVENSON PLACE SUITE #131
FREMONT CA
94539
US

V. Phone/Fax

Practice location:
  • Phone: 510-744-9009
  • Fax: 510-744-9006
Mailing address:
  • Phone: 510-744-9009
  • Fax: 510-744-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: