Provider Demographics
NPI:1073601449
Name:PURI, IPINDER S (DDS)
Entity Type:Individual
Prefix:DR
First Name:IPINDER
Middle Name:S
Last Name:PURI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 HAWTHORNE ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3252
Mailing Address - Country:US
Mailing Address - Phone:651-774-2959
Mailing Address - Fax:651-774-1997
Practice Address - Street 1:828 HAWTHORNE ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3252
Practice Address - Country:US
Practice Address - Phone:651-774-2959
Practice Address - Fax:651-774-1997
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12055OtherSTATE LICENSE