Healthcare Provider Details

I. General information

NPI: 1639588874
Provider Name (Legal Business Name): PRABHJOT KAUR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HIGHLAND SPRINGS AVE STE 11
BEAUMONT CA
92223-2550
US

IV. Provider business mailing address

701 HIGHLAND SPRINGS AVE STE 11
BEAUMONT CA
92223-2550
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-4557
  • Fax: 909-845-3512
Mailing address:
  • Phone: 951-845-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: