Provider Demographics
NPI:1437353653
Name:DR. AHUJA AND DR. GILL'S DENTAL OFFICE
Entity Type:Organization
Organization Name:DR. AHUJA AND DR. GILL'S DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELOISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-386-3650
Mailing Address - Street 1:654 W 4TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3216
Mailing Address - Country:US
Mailing Address - Phone:909-386-3650
Mailing Address - Fax:909-386-3690
Practice Address - Street 1:654 W 4TH ST
Practice Address - Street 2:STE A
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3216
Practice Address - Country:US
Practice Address - Phone:909-386-3650
Practice Address - Fax:909-386-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD43412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty