Provider Demographics
NPI:1023589041
Name:G S KOHLI DENTAL CORP
Entity type:Organization
Organization Name:G S KOHLI DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GAGANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:510-582-1602
Mailing Address - Street 1:20632 REDWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5631
Mailing Address - Country:US
Mailing Address - Phone:510-582-1602
Mailing Address - Fax:510-582-1604
Practice Address - Street 1:20632 REDWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5631
Practice Address - Country:US
Practice Address - Phone:510-582-1602
Practice Address - Fax:510-582-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental