Provider Demographics
NPI:1982779484
Name:GURRINIDER S ATWAL A PROFF DENTAL CORP
Entity Type:Organization
Organization Name:GURRINIDER S ATWAL A PROFF DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GURRINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-435-3060
Mailing Address - Street 1:1162 CHESHIRE CR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506
Mailing Address - Country:US
Mailing Address - Phone:209-814-9993
Mailing Address - Fax:925-964-0190
Practice Address - Street 1:5800 STANFORD RANCH ROAD ST 510
Practice Address - Street 2:STANFORD RANCH ROAD
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765
Practice Address - Country:US
Practice Address - Phone:916-435-3060
Practice Address - Fax:916-435-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty