Provider Demographics
NPI:1437728730
Name:KOONER, TAJ PREET (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAJ
Middle Name:PREET
Last Name:KOONER
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 1:2196 TRINITY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5817
Mailing Address - Country:US
Mailing Address - Phone:734-740-9126
Mailing Address - Fax:
Practice Address - Street 1:2200 N CANTON CENTER RD STE 100A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5037
Practice Address - Country:US
Practice Address - Phone:734-740-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty