Provider Demographics
NPI:1023561602
Name:KOHLI DENTAL CORP
Entity Type:Organization
Organization Name:KOHLI DENTAL CORP
Other - Org Name:NEWARK FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAGANDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-792-9885
Mailing Address - Street 1:5910 THORNTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3800
Mailing Address - Country:US
Mailing Address - Phone:510-792-9885
Mailing Address - Fax:
Practice Address - Street 1:5910 THORNTON AVE STE D
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3800
Practice Address - Country:US
Practice Address - Phone:510-792-9885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty