Provider Demographics
NPI:1902261589
Name:SURJIT CHAHAL DENTAL PROFESSIONAL
Entity type:Organization
Organization Name:SURJIT CHAHAL DENTAL PROFESSIONAL
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:209-634-8000
Mailing Address - Street 1:9761 STEPHENS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DELHI
Mailing Address - State:CA
Mailing Address - Zip Code:95315-9478
Mailing Address - Country:US
Mailing Address - Phone:209-637-8000
Mailing Address - Fax:
Practice Address - Street 1:9761 STEPHENS ST STE B
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:CA
Practice Address - Zip Code:95315-9478
Practice Address - Country:US
Practice Address - Phone:209-637-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty