Provider Demographics
NPI:1821135179
Name:SINGH, GOPAL RAM (DDS)
Entity Type:Individual
Prefix:
First Name:GOPAL
Middle Name:RAM
Last Name:SINGH
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 1:18856 AMAR ROAD
Mailing Address - Street 2:#15
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-7104
Mailing Address - Country:US
Mailing Address - Phone:626-854-6540
Mailing Address - Fax:626-854-6541
Practice Address - Street 1:18856 AMAR ROAD
Practice Address - Street 2:#15
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-7104
Practice Address - Country:US
Practice Address - Phone:626-854-6540
Practice Address - Fax:626-854-6541
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2946901Medicaid