Provider Demographics
NPI:1801234547
Name:CHAHAL, PRABHDEEP KAUR (DMD)
Entity type:Individual
Prefix:DR
First Name:PRABHDEEP KAUR
Middle Name:
Last Name:CHAHAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:PRABHDEEP
Other - Middle Name:
Other - Last Name:SANDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 FOREST GATE CRES
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N2V2X2F
Mailing Address - Country:CA
Mailing Address - Phone:226-868-7791
Mailing Address - Fax:
Practice Address - Street 1:1100 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209
Practice Address - Country:US
Practice Address - Phone:716-829-3717
Practice Address - Fax:716-829-3895
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ0677944390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program