Provider Demographics
NPI:1801435920
Name:SUKHDEEP K KINGRA,D.D.S,INC.
Entity type:Organization
Organization Name:SUKHDEEP K KINGRA,D.D.S,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SUKHDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-423-1551
Mailing Address - Street 1:1717 WHITEASH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5033
Mailing Address - Country:US
Mailing Address - Phone:201-423-1551
Mailing Address - Fax:
Practice Address - Street 1:5657 E KINGS CANYON RD STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4653
Practice Address - Country:US
Practice Address - Phone:559-454-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841607694OtherDENTAL