Provider Demographics
NPI:1720699556
Name:TAUQIR, KANZA (DMD)
Entity Type:Individual
Prefix:
First Name:KANZA
Middle Name:
Last Name:TAUQIR
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 1:1875 N CAMPUS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-8211
Mailing Address - Country:US
Mailing Address - Phone:909-985-2302
Mailing Address - Fax:
Practice Address - Street 1:1875 N CAMPUS AVE STE C
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-8211
Practice Address - Country:US
Practice Address - Phone:909-985-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18587821223G0001X
CA107161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice