1457969669 NPI number — MANVIR KAUR DDS

Table of content: MANVIR KAUR DDS (NPI 1457969669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457969669 NPI number — MANVIR KAUR DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUR
Provider First Name:
MANVIR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457969669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1979 SW 41ST LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97756-6894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-330-7138
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 NE 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADRAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97741-1865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-777-5010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  61085507 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: D12023 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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