Provider Demographics
NPI:1497837942
Name:GOSAL, GURJIT SINGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:GURJIT
Middle Name:SINGH
Last Name:GOSAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10858 STEPHANIE DR
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-2148
Mailing Address - Country:US
Mailing Address - Phone:530-695-2777
Mailing Address - Fax:
Practice Address - Street 1:1275 THARP RD STE A
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2640
Practice Address - Country:US
Practice Address - Phone:530-671-2034
Practice Address - Fax:530-671-8394
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice