Healthcare Provider Details

I. General information

NPI: 1013390483
Provider Name (Legal Business Name): CHHINA DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2015
Last Update Date: 07/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 TARA HILLS DR STE F
PINOLE CA
94564-2533
US

IV. Provider business mailing address

1310 TARA HILLS DR STE F
PINOLE CA
94564-2533
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-6900
  • Fax: 510-724-2707
Mailing address:
  • Phone: 510-724-6900
  • Fax: 510-724-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3799799
License Number StateCA

VIII. Authorized Official

Name: DR. MUNDEEP SINGH CHHINA
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-721-4457