Healthcare Provider Details

I. General information

NPI: 1306728068
Provider Name (Legal Business Name): DAVINDERJIT KAUR SHERGILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16615 CATALONIA DR
RIVERSIDE CA
92504-8701
US

IV. Provider business mailing address

16615 CATALONIA DR
RIVERSIDE CA
92504-8701
US

V. Phone/Fax

Practice location:
  • Phone: 951-314-0893
  • Fax:
Mailing address:
  • Phone: 951-314-0893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12345678
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: