Healthcare Provider Details

I. General information

NPI: 1407565971
Provider Name (Legal Business Name): DR. SUNDEEP SINGH KHAHRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 W FOREST HOME AVE
MILWAUKEE WI
53204-3228
US

IV. Provider business mailing address

10631 TURNBERRY DR
MEQUON WI
53092-6309
US

V. Phone/Fax

Practice location:
  • Phone: 414-277-8960
  • Fax:
Mailing address:
  • Phone: 414-315-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6001283-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: