Provider Demographics
NPI:1346386083
Name:CHAHAL, SURJIT S (DDS)
Entity Type:Individual
Prefix:DR
First Name:SURJIT
Middle Name:S
Last Name:CHAHAL
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 1:1560 GEER RD STE C
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3262
Mailing Address - Country:US
Mailing Address - Phone:209-634-8800
Mailing Address - Fax:209-634-8565
Practice Address - Street 1:1560 GEER RD STE C
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3262
Practice Address - Country:US
Practice Address - Phone:209-634-8800
Practice Address - Fax:209-634-8565
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9193001Medicaid