Provider Demographics
NPI:1902039019
Name:KALRA, SURJIT SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SURJIT
Middle Name:SINGH
Last Name:KALRA
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 1:20472 E PEACH BLOSSOM RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4445
Mailing Address - Country:US
Mailing Address - Phone:909-594-9628
Mailing Address - Fax:
Practice Address - Street 1:1435 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4554
Practice Address - Country:US
Practice Address - Phone:213-739-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist