Provider Demographics
NPI:1134580541
Name:DHILLON, SUPREET KAUR (BDS, DMD)
Entity type:Individual
Prefix:DR
First Name:SUPREET
Middle Name:KAUR
Last Name:DHILLON
Suffix:
Gender:F
Credentials:BDS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 TOWN CENTER BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7115
Mailing Address - Country:US
Mailing Address - Phone:530-802-0031
Mailing Address - Fax:
Practice Address - Street 1:8211 BRUCEVILLE RD STE 155
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2313
Practice Address - Country:US
Practice Address - Phone:916-525-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1013961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice