Provider Demographics
NPI:1588427926
Name:KANSAGRA BECKETT RIDGE MODERN DENTISTRY PC, INC.
Entity type:Organization
Organization Name:KANSAGRA BECKETT RIDGE MODERN DENTISTRY PC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BINDU
Authorized Official - Middle Name:
Authorized Official - Last Name:KANSAGRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-828-6314
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7925 CROSSINGS OF BECKETT DR STE 102
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5811
Practice Address - Country:US
Practice Address - Phone:513-828-6314
Practice Address - Fax:513-898-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty