MEDICARE: DR. PRABHJOT KAUR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	051342	NY

General Provider Information

NPI Number	:	1093900110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRABHJOT KAUR DDS

Provider Business Mailing Address
First Line	:	12807 CEDRIC RD
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-2925
Country	:	US
Telephone Number	:	646-725-6648
Fax Number	:

Provider Business Practice Location Address
First Line	:	3753 91ST ST
Second Line	:	JACKSON HEIGHT
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7901
Country	:	US
Telephone Number	:	718-205-4377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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