Healthcare Provider Details

I. General information

NPI: 1932299658
Provider Name (Legal Business Name): GURBRINDER DHILLON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 S EASTERN AVE 101
LAS VEGAS NV
89123-7936
US

IV. Provider business mailing address

9400 S EASTERN AVE 101
LAS VEGAS NV
89123-7936
US

V. Phone/Fax

Practice location:
  • Phone: 702-456-0009
  • Fax: 702-458-0009
Mailing address:
  • Phone: 702-456-0009
  • Fax: 702-458-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-81
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: