Provider Demographics
NPI:1043618739
Name:GILL, KIRANDEEP (DDS)
Entity Type:Individual
Prefix:
First Name:KIRANDEEP
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DONGAN PL APT 5H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1539
Mailing Address - Country:US
Mailing Address - Phone:510-230-3477
Mailing Address - Fax:
Practice Address - Street 1:11 DONGAN PL APT 5H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1539
Practice Address - Country:US
Practice Address - Phone:510-230-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist