Provider Demographics
NPI:1083015374
Name:KAUR, KAILASH (DMD)
Entity Type:Individual
Prefix:
First Name:KAILASH
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2516
Mailing Address - Country:US
Mailing Address - Phone:646-266-1178
Mailing Address - Fax:
Practice Address - Street 1:23 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2516
Practice Address - Country:US
Practice Address - Phone:646-266-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0112721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice