Provider Demographics
NPI:1346665122
Name:C.G. GHAZAL AND A.K. GILL DENTAL CORPORATION
Entity type:Organization
Organization Name:C.G. GHAZAL AND A.K. GILL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GHAZAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-326-5270
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:1095 HERNDON AVE
Practice Address - Street 2:102
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0504
Practice Address - Country:US
Practice Address - Phone:559-326-5270
Practice Address - Fax:559-326-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty