Healthcare Provider Details

I. General information

NPI: 1801549381
Provider Name (Legal Business Name): KIRANDEEP KAUR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1222 W COLONY RD STE 140
RIPON CA
95366-9482
US

IV. Provider business mailing address

1361 S HART DR
MOUNTAIN HOUSE CA
95391-1483
US

V. Phone/Fax

Practice location:
  • Phone: 209-924-4089
  • Fax: 209-924-4089
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRANDEEP KAUR
Title or Position: OWNER
Credential: DDS
Phone: 646-413-5840