Healthcare Provider Details

I. General information

NPI: 1174487953
Provider Name (Legal Business Name): GILL DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 MCHENRY AVE STE E14
MODESTO CA
95350-1453
US

IV. Provider business mailing address

3440 MCHENRY AVE STE E14
MODESTO CA
95350-1453
US

V. Phone/Fax

Practice location:
  • Phone: 415-355-4141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUKHJIT GILL
Title or Position: CEO
Credential:
Phone: 415-355-4141