Provider Demographics
NPI:1639458896
Name:SARAN, ISHWINDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ISHWINDER
Middle Name:
Last Name:SARAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 5TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5706
Mailing Address - Country:US
Mailing Address - Phone:718-530-6539
Mailing Address - Fax:
Practice Address - Street 1:5002 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5706
Practice Address - Country:US
Practice Address - Phone:718-530-6539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18558351223G0001X
NY50 0574221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program