Healthcare Provider Details

I. General information

NPI: 1508792185
Provider Name (Legal Business Name): DARSHVINDER KAUR PAWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5898 WOODLAND DR
WAUNAKEE WI
53597-8714
US

IV. Provider business mailing address

913 OLD TIMBER PASS
VERONA WI
53593-8530
US

V. Phone/Fax

Practice location:
  • Phone: 608-849-4794
  • Fax:
Mailing address:
  • Phone: 206-900-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6002215-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: