Provider Demographics
NPI:1255573705
Name:KOONER, PAVANDEEP KAUR (DMD)
Entity type:Individual
Prefix:DR
First Name:PAVANDEEP
Middle Name:KAUR
Last Name:KOONER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12776 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:BC
Mailing Address - Zip Code:V3X3M6
Mailing Address - Country:CA
Mailing Address - Phone:1778-858-6232
Mailing Address - Fax:
Practice Address - Street 1:UNIT 108
Practice Address - Street 2:8501 162ND STREET
Practice Address - City:SURREY
Practice Address - State:BC
Practice Address - Zip Code:V4N1B2
Practice Address - Country:CA
Practice Address - Phone:1778-858-6232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA581531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice