Provider Demographics
NPI:1417094616
Name:CHAHAL, RUPINDER KAUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUPINDER
Middle Name:KAUR
Last Name:CHAHAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RUPINDER
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1912 STANDIFORD AVE, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-522-6400
Mailing Address - Fax:209-522-8761
Practice Address - Street 1:1912 STANDIFORD AVE, SUITE 1
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-522-6400
Practice Address - Fax:209-522-8761
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51599122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD51599Medicaid