Basic Information
Provider Information
NPI: 1740443175
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GHUMAN
FirstName: RUPAUL
MiddleName: SINGH
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX A D
Address2:  
City: YUBA CITY
State: CA
PostalCode: 959921396
CountryCode: US
TelephoneNumber: 5307513769
FaxNumber: 5307511237
Practice Location
Address1: 2800 LINCOLN BLVD
Address2:  
City: OROVILLE
State: CA
PostalCode: 959665961
CountryCode: US
TelephoneNumber: 5305336484
FaxNumber: 5305332708
Other Information
ProviderEnumerationDate: 07/07/2008
LastUpdateDate: 11/09/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X57080CAY Dental ProvidersDentistGeneral Practice

No ID Information.


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