Provider Demographics
NPI:1083450787
Name:SRAN, KANWER PAUL SINGH (DMD)
Entity type:Individual
Prefix:
First Name:KANWER PAUL
Middle Name:SINGH
Last Name:SRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9892 SHORE BREAK LN APT 203
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-2963
Mailing Address - Country:US
Mailing Address - Phone:408-768-6413
Mailing Address - Fax:
Practice Address - Street 1:314 FRANKLIN AVE STE 305
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1238
Practice Address - Country:US
Practice Address - Phone:410-629-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD181801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice