MEDICARE: DR. GAGANDEEP 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	0401418931	VA

General Provider Information

NPI Number	:	1831939305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAGANDEEP KAUR

Provider Business Mailing Address
First Line	:	9227 MATTHEW DR
Second Line	:
City	:	MANASSAS PARK
State	:	VA
Zip	:	20111-2451
Country	:	US
Telephone Number	:	718-350-1047
Fax Number	:

Provider Business Practice Location Address
First Line	:	12351 DILLINGHAM SQ
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-5251
Country	:	US
Telephone Number	:	718-350-1047
Fax Number	:

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

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	05/30/2024

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