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General NPI Number Information
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NPI Number | 1457837189
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Entity Type | Organization
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Legal Business Name | KSB DENTAL LLC
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 7330 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19136-3828
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Country | US
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Telephone | 848-219-5963
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Fax |
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Provider Business Mailing Address
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Address Line | 9A HARRISON AVE
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City | CARTERET
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State | NJ
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Zip | 07008
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Country | US
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Telephone | 848-219-5963
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. KARANDEEP SINGH BRAR
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Credential | DMD
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Telephone | 848-219-5963
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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 | DSO41413
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License Number State | PA
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