=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487039509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TEJINDER DHERI DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2015
-----------------------------------------------------
Last Update Date | 03/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1047 LIVE OAK BLVD
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95991-3443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-673-7171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3375 BRANDYWINE CT
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95993-9077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-755-6087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS040487
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 63013
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------