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NPI Code Detail

MEDICARE: SIMERDEEP GILL DDS, A PROFESSIONAL DENTAL CORPORATION

MEDICARE: SIMERDEEP GILL DDS, A PROFESSIONAL DENTAL CORPORATION
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1679038715
Entity Type Code : Organization
Provider Name (Legal Business Name) : SIMERDEEP GILL DDS, A PROFESSIONAL DENTAL CORPORATION
Provider Business Mailing Address
First Line : 9446 N PRICE AVE
Second Line :
City : FRESNO
State : CA
Zip : 93720-4168
Country : US
Telephone Number : 559-360-2491
Fax Number : 559-226-5657
Provider Business Practice Location Address
First Line : 434 W SHAW AVE
Second Line :
City : FRESNO
State : CA
Zip : 93704-2511
Country : US
Telephone Number : 559-226-2211
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. SIMERDEEP GILL
Credential : DDS
Telephone Number : 559-360-2491
Provider Enumeration Date : 02/03/2019
Last Update Date : 02/03/2019

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Directions to “SIMERDEEP GILL DDS, A PROFESSIONAL DENTAL CORPORATION ” Practice Location

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