Basic Information
Provider Information
NPI: 1205250891
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAHLON
FirstName: GAGANDEEP
MiddleName: S.
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6300 WEST LOOP S STE 650
Address2:  
City: BELLAIRE
State: TX
PostalCode: 774012997
CountryCode: US
TelephoneNumber: 7134573445
FaxNumber:  
Practice Location
Address1: 1997 KATY MILLS BLVD
Address2: #500
City: KATY
State: TX
PostalCode: 774944958
CountryCode: US
TelephoneNumber: 7134573445
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/18/2014
LastUpdateDate: 12/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X29694TXY Dental ProvidersDentistGeneral Practice

No ID Information.


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