Provider Demographics
NPI:1275835803
Name:RANA, KRUNAL S (DDS)
Entity Type:Individual
Prefix:
First Name:KRUNAL
Middle Name:S
Last Name:RANA
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 1:77 PENNINGTON AVE
Mailing Address - Street 2:APT C8
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4841
Mailing Address - Country:US
Mailing Address - Phone:862-571-6883
Mailing Address - Fax:
Practice Address - Street 1:1070 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-1453
Practice Address - Country:US
Practice Address - Phone:413-737-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18555971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice