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General NPI Number Information
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NPI Number | 1083015374
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Entity Type | Individual
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Provider Name | KAILASH KAUR DMD
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Gender | Female
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 23 FAIRVIEW DR
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City | FARMINGTON
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State | CT
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Zip | 06032-2516
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Country | US
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Telephone | 646-266-1178
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Fax |
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Provider Business Mailing Address
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Address Line | 23 FAIRVIEW DR
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City | FARMINGTON
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State | CT
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Zip | 06032-2516
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Country | US
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Telephone | 646-266-1178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 011272
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License Number State | CT
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