Provider Demographics
NPI:1750169777
Name:GILL, PARDEEP SINGH (DDS)
Entity type:Individual
Prefix:
First Name:PARDEEP
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 1:224 S CLOVIS AVE APT 125
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4280
Mailing Address - Country:US
Mailing Address - Phone:630-956-0886
Mailing Address - Fax:
Practice Address - Street 1:1124 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1939
Practice Address - Country:US
Practice Address - Phone:630-956-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1093321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice