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General NPI Number Information
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NPI Number | 1063819670
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Entity Type | Organization
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Legal Business Name | GURNEET CHAHAL DDS CORP
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 250 S OAK AVE
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City | OAKDALE
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State | CA
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Zip | 95361-3572
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Country | US
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Telephone | 209-288-4089
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Fax |
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Provider Business Mailing Address
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Address Line | 250 S OAK AVE
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City | OAKDALE
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State | CA
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Zip | 95361-3572
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Country | US
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Telephone | 209-288-4089
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GURNEET CHAHAL
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Credential | DDS
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Telephone | 707-631-3035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 51905
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License Number State | CA
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