Provider Demographics
NPI:1770594848
Name:GURAM, MONJIT S (DDS)
Entity type:Individual
Prefix:DR
First Name:MONJIT
Middle Name:S
Last Name:GURAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 YUCCA AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-6067
Mailing Address - Country:US
Mailing Address - Phone:817-927-8500
Mailing Address - Fax:817-927-8508
Practice Address - Street 1:3825 YUCCA AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-6067
Practice Address - Country:US
Practice Address - Phone:817-927-8500
Practice Address - Fax:817-927-8508
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice