Healthcare Provider Details

I. General information

NPI: 1568156487
Provider Name (Legal Business Name): PRANAV KUKREJA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 W MAIN ST
FRANKLIN TN
37064-3468
US

IV. Provider business mailing address

1420 ADAMS ST APT 454
NASHVILLE TN
37208-3429
US

V. Phone/Fax

Practice location:
  • Phone: 615-383-6787
  • Fax:
Mailing address:
  • Phone: 205-478-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12582
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: