Provider Demographics
NPI:1124257225
Name:KAUR, MANDEEP (DDS)
Entity type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
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:PO BOX 53556
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95153-0556
Mailing Address - Country:US
Mailing Address - Phone:650-777-4391
Mailing Address - Fax:
Practice Address - Street 1:3151 S WHITE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4045
Practice Address - Country:US
Practice Address - Phone:408-223-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice