Provider Demographics
NPI:1154520724
Name:KAUR, GAGAN DEEP (DDS)
Entity type:Individual
Prefix:
First Name:GAGAN
Middle Name:DEEP
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 1:24411 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-6200
Mailing Address - Country:US
Mailing Address - Phone:646-265-3740
Mailing Address - Fax:
Practice Address - Street 1:2525 W CAREFREE HWY
Practice Address - Street 2:BLDG 2 SUITE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6093
Practice Address - Country:US
Practice Address - Phone:623-533-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist