Provider Demographics
NPI:1508022914
Name:BIR, GURPREET KAUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GURPREET
Middle Name:KAUR
Last Name:BIR
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 1:22675 ALESSANDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8551
Mailing Address - Country:US
Mailing Address - Phone:951-571-2300
Mailing Address - Fax:951-571-2330
Practice Address - Street 1:18601 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-1831
Practice Address - Country:US
Practice Address - Phone:909-877-0510
Practice Address - Fax:909-877-5468
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70324FMedicaid
CAG9805401Medicare Oscar/Certification
CAG9805402Medicare Oscar/Certification
CAFHC70324FMedicaid
CAG9805404Medicare Oscar/Certification