Provider Demographics
NPI:1932440336
Name:KINGSLEY, KIRAN AGARWAL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:AGARWAL
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14344 BURNHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4928
Mailing Address - Country:US
Mailing Address - Phone:612-604-0409
Mailing Address - Fax:
Practice Address - Street 1:14344 BURNHAVEN DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4928
Practice Address - Country:US
Practice Address - Phone:612-604-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-09
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS1051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics