Provider Demographics
NPI:1790661841
Name:RATTU, KAMALJOT KAUR (DDS)
Entity type:Individual
Prefix:
First Name:KAMALJOT
Middle Name:KAUR
Last Name:RATTU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SKYLARK DR APT 128
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1257
Mailing Address - Country:US
Mailing Address - Phone:925-409-8687
Mailing Address - Fax:
Practice Address - Street 1:6315 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2403
Practice Address - Country:US
Practice Address - Phone:707-584-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1122461223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice