1366870693 NPI number — GURMINDER S. UPPAL, DDS DENTAL CORP.

Table of content: MS. TRENITA LASHAWN MOORE CFNP (NPI 1225239411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366870693 NPI number — GURMINDER S. UPPAL, DDS DENTAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GURMINDER S. UPPAL, DDS DENTAL CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366870693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3221 MADDEN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94568-7216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1807 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CERES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95307-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-537-7357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
UPPAL
Authorized Official First Name:
GURMINDER
Authorized Official Middle Name:
SIDHU
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
415-810-4541

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  56914 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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