Provider Demographics
NPI:1902963051
Name:KOHLI, GAGANDEEP SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAGANDEEP
Middle Name:SINGH
Last Name:KOHLI
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 1:16177 HESPERIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-2451
Mailing Address - Country:US
Mailing Address - Phone:510-276-6930
Mailing Address - Fax:510-276-1061
Practice Address - Street 1:16177 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-2451
Practice Address - Country:US
Practice Address - Phone:510-276-6930
Practice Address - Fax:510-276-1061
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist