Provider Demographics
NPI:1447603600
Name:GILL, PRITPAL (DDS)
Entity Type:Individual
Prefix:
First Name:PRITPAL
Middle Name:
Last Name:GILL
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 1:9090 PEMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1340
Mailing Address - Country:US
Mailing Address - Phone:347-463-8209
Mailing Address - Fax:
Practice Address - Street 1:10044 BRUCEVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-9504
Practice Address - Country:US
Practice Address - Phone:347-463-8209
Practice Address - Fax:347-463-8209
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist