Provider Demographics
NPI:1255843009
Name:KAUR, GAGANDEEP (DMD)
Entity Type:Individual
Prefix:
First Name:GAGANDEEP
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 1:1430 N. CENTRAL AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323
Mailing Address - Country:US
Mailing Address - Phone:623-932-0539
Mailing Address - Fax:
Practice Address - Street 1:1430 N. CENTRAL AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:623-932-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0098421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice