Provider Demographics
NPI:1720212236
Name:GUGALE DENTAL INC
Entity Type:Organization
Organization Name:GUGALE DENTAL INC
Other - Org Name:WHEATLAND DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:SACHIN
Authorized Official - Last Name:GUGALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-408-8769
Mailing Address - Street 1:1390 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8260
Mailing Address - Country:US
Mailing Address - Phone:916-408-8769
Mailing Address - Fax:
Practice Address - Street 1:615 OLIVE ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:CA
Practice Address - Zip Code:95692-9787
Practice Address - Country:US
Practice Address - Phone:530-633-2865
Practice Address - Fax:530-633-9491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty