Healthcare Provider Details

I. General information

NPI: 1497156145
Provider Name (Legal Business Name): KANWARPAL SINGH DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MIDDLE TPKE W
MANCHESTER CT
06040-3833
US

IV. Provider business mailing address

419 MIDDLE TPKE W
MANCHESTER CT
06040-3833
US

V. Phone/Fax

Practice location:
  • Phone: 954-798-0320
  • Fax:
Mailing address:
  • Phone: 954-798-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10315
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10315
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KANWARPAL SINGH
Title or Position: SOLE OWNER
Credential: DDS
Phone: 954-798-0320