Provider Demographics
NPI:1821838657
Name:KHAIRA, MANJINDER KAUR
Entity type:Individual
Prefix:
First Name:MANJINDER
Middle Name:KAUR
Last Name:KHAIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 NANTUCKET RD APT B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-2153
Mailing Address - Country:US
Mailing Address - Phone:734-306-8444
Mailing Address - Fax:
Practice Address - Street 1:2442 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2050
Practice Address - Country:US
Practice Address - Phone:815-748-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0351101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice