Provider Demographics
NPI:1033878079
Name:KILLINGLY KIDS DENTIST
Entity Type:Organization
Organization Name:KILLINGLY KIDS DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GURSIMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHLUWALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-306-1270
Mailing Address - Street 1:9 WILLOW WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6043
Mailing Address - Country:US
Mailing Address - Phone:860-932-6110
Mailing Address - Fax:860-932-6113
Practice Address - Street 1:KILLINGLY KIDS DENTIST
Practice Address - Street 2:559 HARTFORD PIKE, SUITE C
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-0154
Practice Address - Country:US
Practice Address - Phone:617-306-1270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty