Healthcare Provider Details

I. General information

NPI: 1871057067
Provider Name (Legal Business Name): JAGDEV SINGH HEIR MD PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 TRUXEL RD STE C
SACRAMENTO CA
95834-3758
US

IV. Provider business mailing address

4170 TRUXEL RD STE C
SACRAMENTO CA
95834-3758
US

V. Phone/Fax

Practice location:
  • Phone: 916-419-4588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. JAGDEV SINGH HEIR
Title or Position: PRESIDENT & CEO
Credential: MD, DMD, FACS
Phone: 518-441-5483