Healthcare Provider Details

I. General information

NPI: 1487039509
Provider Name (Legal Business Name): TEJINDER DHERI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 LIVE OAK BLVD
YUBA CITY CA
95991-3443
US

IV. Provider business mailing address

3375 BRANDYWINE CT
YUBA CITY CA
95993-9077
US

V. Phone/Fax

Practice location:
  • Phone: 530-673-7171
  • Fax:
Mailing address:
  • Phone: 530-755-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040487
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: