Provider Demographics
NPI:1578164570
Name:NIMRAT DHILLON DENTAL CORP
Entity Type:Organization
Organization Name:NIMRAT DHILLON DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIMRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:083-108-2524
Mailing Address - Street 1:1325 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4735
Mailing Address - Country:US
Mailing Address - Phone:669-327-5623
Mailing Address - Fax:669-327-5386
Practice Address - Street 1:1325 1ST ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4735
Practice Address - Country:US
Practice Address - Phone:669-327-5623
Practice Address - Fax:669-327-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235502097OtherNPI