Provider Demographics
NPI:1902107527
Name:G. S. ATWAL, DDS A PROF. DENTAL CORP
Entity Type:Organization
Organization Name:G. S. ATWAL, DDS A PROF. DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
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:209-836-5393
Mailing Address - Street 1:14850 HIGHWAY 4 STE B
Mailing Address - Street 2:
Mailing Address - City:DISCOVERY BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94505-2237
Mailing Address - Country:US
Mailing Address - Phone:925-634-5353
Mailing Address - Fax:925-634-5393
Practice Address - Street 1:14850 HIGHWAY 4 STE B
Practice Address - Street 2:
Practice Address - City:DISCOVERY BAY
Practice Address - State:CA
Practice Address - Zip Code:94505-2237
Practice Address - Country:US
Practice Address - Phone:925-634-5353
Practice Address - Fax:925-634-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty