Provider Demographics
NPI:1477703304
Name:KANSAGRA, BINDU B (DDS)
Entity Type:Individual
Prefix:DR
First Name:BINDU
Middle Name:B
Last Name:KANSAGRA
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 1:14382 RED HILL AVE
Mailing Address - Street 2:UNIT #21
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-679-9883
Mailing Address - Fax:
Practice Address - Street 1:14382 RED HILL AVE APT 21
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6267
Practice Address - Country:US
Practice Address - Phone:714-679-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025643122300000X
CA57691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist