Provider Demographics
NPI:1013180363
Name:KANSAGRA, PARIMAL JINABHAI (DDS,MDS)
Entity Type:Individual
Prefix:
First Name:PARIMAL
Middle Name:JINABHAI
Last Name:KANSAGRA
Suffix:
Gender:M
Credentials:DDS,MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 FOOTHILL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3062
Mailing Address - Country:US
Mailing Address - Phone:909-596-1155
Mailing Address - Fax:909-596-6633
Practice Address - Street 1:2488 FOOTHILL BLVD STE C
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3062
Practice Address - Country:US
Practice Address - Phone:909-596-1155
Practice Address - Fax:909-596-6633
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist