Provider Demographics
NPI:1508343476
Name:P KANSAGRA DDS INC
Entity Type:Organization
Organization Name:P KANSAGRA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARIMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANSAGRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-974-5599
Mailing Address - Street 1:8285 E SANTA ANA CANYON RD STE 115
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2250
Mailing Address - Country:US
Mailing Address - Phone:714-974-5599
Mailing Address - Fax:
Practice Address - Street 1:8285 E SANTA ANA CANYON RD STE 115
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2250
Practice Address - Country:US
Practice Address - Phone:714-974-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty