MEDICARE: KIRTAN KAUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7598	OK

General Provider Information

NPI Number	:	1306578182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRTAN KAUR

Provider Business Mailing Address
First Line	:	500 CENTRAL PARK DR APT 914
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-1738
Country	:	US
Telephone Number	:	646-393-7545
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 S LEWIS AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-6539
Country	:	US
Telephone Number	:	918-770-0870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	07/05/2022

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Directions to “ KIRTAN KAUR ” Practice Location

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