MEDICARE: G. S. ATWAL, DDS A PROF. DENTAL CORP

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	1223G0001X	General Practice Dentistry	46021	CA

General Provider Information

NPI Number	:	1902107527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G. S. ATWAL, DDS A PROF. DENTAL CORP

Provider Business Mailing Address
First Line	:	14850 HIGHWAY 4 STE B
Second Line	:
City	:	DISCOVERY BAY
State	:	CA
Zip	:	94505-2237
Country	:	US
Telephone Number	:	925-634-5353
Fax Number	:	925-634-5393

Provider Business Practice Location Address
First Line	:	14850 HIGHWAY 4 STE B
Second Line	:
City	:	DISCOVERY BAY
State	:	CA
Zip	:	94505-2237
Country	:	US
Telephone Number	:	925-634-5353
Fax Number	:	925-634-5393

Authorized Official
Title or Position	:	DENTIST
Name	:	GURRINDER SINGH ATWAL
Credential	:	D.D.S.
Telephone Number	:	209-836-5393

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	11/12/2010

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