Healthcare Provider Details

I. General information

NPI: 1750886651
Provider Name (Legal Business Name): KIRANDEEP KAUR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
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

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

V. Phone/Fax

Practice location:
  • Phone: 646-413-5840
  • Fax:
Mailing address:
  • Phone: 646-413-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIRANDEEP KAUR
Title or Position: PRESIDENT
Credential: DDS
Phone: 646-413-5840