Healthcare Provider Details

I. General information

NPI: 1669235412
Provider Name (Legal Business Name): GURSHARANJIT SINGH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4817 MAHONING AVE NW
WARREN OH
44483-1430
US

IV. Provider business mailing address

14184 SHELDON RD
BROOKPARK OH
44142-3863
US

V. Phone/Fax

Practice location:
  • Phone: 330-847-0676
  • Fax:
Mailing address:
  • Phone: 330-847-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028012
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: