Provider Demographics
NPI:1922533785
Name:PROVIDENCE DENTAL DHILLON PLLC
Entity Type:Organization
Organization Name:PROVIDENCE DENTAL DHILLON PLLC
Other - Org Name:SUMMER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GURBRINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-852-2755
Mailing Address - Street 1:10965 LAVENDER HILL DR
Mailing Address - Street 2:# 6200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2950
Mailing Address - Country:US
Mailing Address - Phone:702-852-2755
Mailing Address - Fax:702-947-4944
Practice Address - Street 1:10965 LAVENDER HILL DR
Practice Address - Street 2:# 6200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-2950
Practice Address - Country:US
Practice Address - Phone:702-852-2755
Practice Address - Fax:702-947-4944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE DENTAL DHILLON PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-811223E0200X, 1223G0001X, 1223P0221X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty