Provider Demographics
NPI:1598848319
Name:GILL, SUNDEEP SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUNDEEP
Middle Name:SINGH
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 1:37544 NEWBURGH PARK CIR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1372
Mailing Address - Country:US
Mailing Address - Phone:313-701-8536
Mailing Address - Fax:
Practice Address - Street 1:302 W AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6039
Practice Address - Country:US
Practice Address - Phone:313-842-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI182521223G0001X
FLDN 158251223G0001X
AZ77101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4383231Medicaid