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General NPI Number Information
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NPI Number | 1043899016
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Entity Type | Organization
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Legal Business Name | A S GILL DENTAL CORP
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 1518 COFFEE RD STE B
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City | MODESTO
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State | CA
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Zip | 95355-3164
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Country | US
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Telephone | 209-809-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 1548 MAEHL DR
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City | MANTECA
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State | CA
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Zip | 95337-7215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AMANDEEP SINGH GILL
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Credential | DDS
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Telephone | 646-275-6836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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