Provider Demographics
NPI:1467901975
Name:GAGANDEEP S KANDOLA, DMD INC.
Entity Type:Organization
Organization Name:GAGANDEEP S KANDOLA, DMD INC.
Other - Org Name:SYNERGY DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAGANDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KANDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-933-4646
Mailing Address - Street 1:1150 SUNCAST LN
Mailing Address - Street 2:#6
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9324
Mailing Address - Country:US
Mailing Address - Phone:916-933-4646
Mailing Address - Fax:
Practice Address - Street 1:1150 SUNCAST LN
Practice Address - Street 2:#6
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9324
Practice Address - Country:US
Practice Address - Phone:916-933-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty