Provider Demographics
NPI:1619491933
Name:KUMAR, DEEPIKA (DDS)
Entity Type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:
Last Name:KUMAR
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 1:4140 THIELMAN LN STE 302
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3897
Mailing Address - Country:US
Mailing Address - Phone:320-252-7752
Mailing Address - Fax:320-252-2289
Practice Address - Street 1:4140 THIELMAN LN STE 302
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3897
Practice Address - Country:US
Practice Address - Phone:320-252-7752
Practice Address - Fax:320-252-2289
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty