Provider Demographics
NPI:1942511191
Name:AHLUWALIA, GURSIMRAN SINGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:GURSIMRAN
Middle Name:SINGH
Last Name:AHLUWALIA
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 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:KINDRED SMILES PEDIATRIC DENTISTRY
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1379
Practice Address - Country:US
Practice Address - Phone:978-448-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18562161223P0221X
IL019028368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110095989AMedicaid