Healthcare Provider Details

I. General information

NPI: 1013001460
Provider Name (Legal Business Name): GURINDER SINGH WADHWA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 STATE ST
SCHENECTADY NY
12307-1508
US

IV. Provider business mailing address

5 PALISADES DR SUITE 210
ALBANY NY
12205-6433
US

V. Phone/Fax

Practice location:
  • Phone: 518-370-1441
  • Fax:
Mailing address:
  • Phone: 518-348-0634
  • Fax: 518-426-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number034917
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: