Provider Demographics
NPI:1922643899
Name:GILL, SIMRAN SINGH (DDS)
Entity Type:Individual
Prefix:
First Name:SIMRAN
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 1:2400 POLE LINE RD APT 35
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-0525
Mailing Address - Country:US
Mailing Address - Phone:215-433-4778
Mailing Address - Fax:
Practice Address - Street 1:110 NUT TREE PKWY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3251
Practice Address - Country:US
Practice Address - Phone:707-451-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1045351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104535OtherDENTAL LICENSE NUMBER