Provider Demographics
NPI:1538803457
Name:KANSAGRA DENTISTS OF SHARONVILLE PC, INC
Entity type:Organization
Organization Name:KANSAGRA DENTISTS OF SHARONVILLE PC, INC
Other - Org Name:<UNAVAIL>
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:513-440-6903
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:714-845-8890
Mailing Address - Fax:
Practice Address - Street 1:12197 LEBANON ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:SHARONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45241
Practice Address - Country:US
Practice Address - Phone:513-440-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty