Provider Demographics
NPI:1073169850
Name:HARSIRAT GONDARA, DDS, INC.
Entity Type:Organization
Organization Name:HARSIRAT GONDARA, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARSIRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GONDARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-789-6417
Mailing Address - Street 1:2327 BENTLEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2424
Mailing Address - Country:US
Mailing Address - Phone:408-688-4923
Mailing Address - Fax:
Practice Address - Street 1:795 COCHRANE RD STE 120
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2874
Practice Address - Country:US
Practice Address - Phone:510-789-6417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty