Provider Demographics
NPI:1184609745
Name:GILL, DAMANJIT SINGH (DDS)
Entity type:Individual
Prefix:
First Name:DAMANJIT
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 1:2242 W GRANT LINE RD
Mailing Address - Street 2:SUITE#102
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7329
Mailing Address - Country:US
Mailing Address - Phone:209-832-2525
Mailing Address - Fax:
Practice Address - Street 1:2242 W GRANT LINE RD
Practice Address - Street 2:SUITE#102
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7329
Practice Address - Country:US
Practice Address - Phone:209-832-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice