MEDICARE: GUNDEEP SINGH D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.028353	IL

General Provider Information

NPI Number	:	1295047306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUNDEEP SINGH D.D.S

Provider Business Mailing Address
First Line	:	1812 CHURCHILL LN
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 CHURCHILL LN
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1303
Country	:	US
Telephone Number	:	630-580-4120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	07/06/2010

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