Provider Demographics
NPI:1316343775
Name:SAMRA, MANJEET SINGH (DDS)
Entity type:Individual
Prefix:DR
First Name:MANJEET
Middle Name:SINGH
Last Name:SAMRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W ROBINHOOD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5606
Mailing Address - Country:US
Mailing Address - Phone:209-923-3013
Mailing Address - Fax:
Practice Address - Street 1:1110 W ROBINHOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5606
Practice Address - Country:US
Practice Address - Phone:209-923-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist