Provider Demographics
NPI:1699272088
Name:AURORA, GUR SIMRAN
Entity type:Individual
Prefix:
First Name:GUR SIMRAN
Middle Name:
Last Name:AURORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E HAWKINS PKWY APT 1206
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-8043
Mailing Address - Country:US
Mailing Address - Phone:339-234-3232
Mailing Address - Fax:
Practice Address - Street 1:3052 N EASTMAN RD STE 108
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5013
Practice Address - Country:US
Practice Address - Phone:903-686-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice