Healthcare Provider Details

I. General information

NPI: 1922926401
Provider Name (Legal Business Name): GILL DENTAL TRACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 W GRANT LINE RD STE 117
TRACY CA
95377-7327
US

IV. Provider business mailing address

2271 W GRANT LINE RD STE 117
TRACY CA
95377-7327
US

V. Phone/Fax

Practice location:
  • Phone: 209-597-7039
  • Fax:
Mailing address:
  • Phone: 209-597-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AMANDEEP S GILL
Title or Position: OWNER
Credential:
Phone: 646-275-6836