Healthcare Provider Details

I. General information

NPI: 1073878021
Provider Name (Legal Business Name): KIRANDEEP KAUR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 COPPER COVE DR STE A
COPPEROPOLIS CA
95228-9373
US

IV. Provider business mailing address

1361 S HART DR
MOUNTAIN HOUSE CA
95391-1483
US

V. Phone/Fax

Practice location:
  • Phone: 646-812-6130
  • Fax:
Mailing address:
  • Phone: 646-812-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD13143
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number101983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: