Provider Demographics
NPI:1083870109
Name:GUPTA GILL ABDOLHOSSEINI DDS INC
Entity Type:Organization
Organization Name:GUPTA GILL ABDOLHOSSEINI DDS INC
Other - Org Name:PINE CENTER DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOLHOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-597-2477
Mailing Address - Street 1:5771 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6529
Mailing Address - Country:US
Mailing Address - Phone:909-597-2477
Mailing Address - Fax:909-597-3772
Practice Address - Street 1:5771 PINE AVE
Practice Address - Street 2:STE S
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6529
Practice Address - Country:US
Practice Address - Phone:909-597-2477
Practice Address - Fax:909-597-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty