MEDICARE: DR. SUKHVINDER KAUR GURAM D.M.D.

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	1601	FL
2	1223G0001X	General Practice Dentistry	8836	SC
3	1223P0221X	Pediatric Dentistry	978PD	SC

General Provider Information

NPI Number	:	1891148698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUKHVINDER KAUR GURAM D.M.D.

Provider Business Mailing Address
First Line	:	260 WOOD MOOR PL
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-2712
Country	:	US
Telephone Number	:	803-429-7401
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 N LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2833
Country	:	US
Telephone Number	:	803-429-7401
Fax Number	:

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

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	12/22/2020

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