Provider Demographics
NPI:1063832814
Name:SAHOTA, GURSHAWN SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GURSHAWN
Middle Name:SINGH
Last Name:SAHOTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 MOWRY AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1700
Mailing Address - Country:US
Mailing Address - Phone:510-557-3180
Mailing Address - Fax:
Practice Address - Street 1:1895 MOWRY AVE STE 111
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1700
Practice Address - Country:US
Practice Address - Phone:510-557-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-20
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633401223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice