Provider Demographics
NPI:1427524073
Name:NISHANDEEP CHAHAL DENTAL CORP
Entity type:Organization
Organization Name:NISHANDEEP CHAHAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-667-5405
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360-0820
Mailing Address - Country:US
Mailing Address - Phone:209-862-0777
Mailing Address - Fax:
Practice Address - Street 1:1925 N ST STE E
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1419
Practice Address - Country:US
Practice Address - Phone:209-862-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherSTATE OF CALIFORNIA