Provider Demographics
NPI:1013355841
Name:KANDOLA, GAGANDEEP SINGH (DMD)
Entity Type:Individual
Prefix:
First Name:GAGANDEEP
Middle Name:SINGH
Last Name:KANDOLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 COUNTRY ROADS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3214
Mailing Address - Country:US
Mailing Address - Phone:916-730-3674
Mailing Address - Fax:
Practice Address - Street 1:9620 COUNTRY ROADS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3214
Practice Address - Country:US
Practice Address - Phone:916-730-3674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist