Provider Demographics
NPI:1891148698
Name:GURAM, SUKHVINDER KAUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUKHVINDER
Middle Name:KAUR
Last Name:GURAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SUKHI
Other - Middle Name:KAUR
Other - Last Name:GURAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:260 WOOD MOOR PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2712
Mailing Address - Country:US
Mailing Address - Phone:803-429-7401
Mailing Address - Fax:
Practice Address - Street 1:203 N LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2833
Practice Address - Country:US
Practice Address - Phone:803-429-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1601122300000X
SC88361223G0001X
SC978PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice