Provider Demographics
NPI:1710580972
Name:KAUR, MANDEEP (DE61102590)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:DE61102590
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 W VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5503
Mailing Address - Country:US
Mailing Address - Phone:425-251-6044
Mailing Address - Fax:425-251-6088
Practice Address - Street 1:16600 W VALLEY HWY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-5503
Practice Address - Country:US
Practice Address - Phone:425-251-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611025901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice