Provider Demographics
NPI:1215697396
Name:MANJINDER KAUR, XXX (DPH)
Entity type:Individual
Prefix:DR
First Name:XXX
Middle Name:
Last Name:MANJINDER KAUR
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S JEFFERSON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-5647
Mailing Address - Country:US
Mailing Address - Phone:469-233-0550
Mailing Address - Fax:
Practice Address - Street 1:1401 S JEFFERSON AVE STE 4
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5647
Practice Address - Country:US
Practice Address - Phone:469-233-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX380451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice