Provider Demographics
NPI:1558629386
Name:AMARDEEP GILL, D.D.S., INC.
Entity Type:Organization
Organization Name:AMARDEEP GILL, D.D.S., INC.
Other - Org Name:BRENTWOOD SMILES DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMARDEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-513-8363
Mailing Address - Street 1:2860 MICHELLE DRIVE 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606
Mailing Address - Country:US
Mailing Address - Phone:714-368-2077
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:6660 LONE TREE WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5370
Practice Address - Country:US
Practice Address - Phone:925-513-8363
Practice Address - Fax:925-513-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty