Provider Demographics
NPI:1811352404
Name:CHAHAL DENTAL CORPORATION
Entity type:Organization
Organization Name:CHAHAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SURJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-521-3400
Mailing Address - Street 1:2217 COFFEE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2307
Mailing Address - Country:US
Mailing Address - Phone:209-521-3400
Mailing Address - Fax:209-521-9600
Practice Address - Street 1:2217 COFFEE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2307
Practice Address - Country:US
Practice Address - Phone:209-521-3400
Practice Address - Fax:209-521-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty