Provider Demographics
NPI:1396973319
Name:GILL, MANKIRAT (DDS)
Entity type:Individual
Prefix:DR
First Name:MANKIRAT
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MANKIRAT
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8835 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1832
Mailing Address - Country:US
Mailing Address - Phone:559-495-9600
Mailing Address - Fax:559-271-8401
Practice Address - Street 1:3616 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3231
Practice Address - Country:US
Practice Address - Phone:559-271-8400
Practice Address - Fax:559-271-8401
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA58363OtherDENTAL LICENSE