MEDICARE: AMAN 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	D010434	AZ

General Provider Information

NPI Number	:	1396398806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMAN KAUR

Provider Business Mailing Address
First Line	:	3320 W SOUTHERN AVE STE 111
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-4307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 W SOUTHERN AVE STE 111
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-4307
Country	:	US
Telephone Number	:	602-305-8800
Fax Number	:

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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Directions to “ AMAN KAUR ” Practice Location

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