Healthcare Provider Details

I. General information

NPI: 1215628607
Provider Name (Legal Business Name): DR. PAVANPREET KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 LEE RD STE 260
CLEVELAND OH
44128-2173
US

IV. Provider business mailing address

9376 ADAM RUN
TWINSBURG OH
44087-3812
US

V. Phone/Fax

Practice location:
  • Phone: 216-727-0234
  • Fax:
Mailing address:
  • Phone: 216-355-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028152
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: