Healthcare Provider Details

I. General information

NPI: 1326333477
Provider Name (Legal Business Name): MANDEEP SINGH HURA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 07/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 FRANKLIN ST
STAMFORD CT
06901
US

IV. Provider business mailing address

115 FILLOW ST APT 4
NORWALK CT
06850-2842
US

V. Phone/Fax

Practice location:
  • Phone: 203-969-0802
  • Fax:
Mailing address:
  • Phone: 410-603-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10584
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number010584
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: