=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598557993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MK DDS EWING PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2025
-----------------------------------------------------
Last Update Date | 05/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 PARKWAY AVE
-----------------------------------------------------
City | EWING
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08618-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-323-0700
-----------------------------------------------------
Fax | 862-832-3710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 960 PARKWAY AVE
-----------------------------------------------------
City | EWING
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08618-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-323-0700
-----------------------------------------------------
Fax | 862-832-3710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MANREET KAUR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 609-323-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------