Provider Demographics
NPI:1831531722
Name:KUCKREJA, MANMEET KAUR (DDS)
Entity type:Individual
Prefix:DR
First Name:MANMEET
Middle Name:KAUR
Last Name:KUCKREJA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N. CLARK STREET, 6TH FLOOR
Mailing Address - Street 2:DENTAL DREAMS LLC, C/O JULIETTE BOYCE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654
Mailing Address - Country:US
Mailing Address - Phone:312-274-4520
Mailing Address - Fax:
Practice Address - Street 1:3302 N FIFTH ST HIGHWAY
Practice Address - Street 2:DENTAL DREAMS LLC
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605
Practice Address - Country:US
Practice Address - Phone:610-929-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS0397141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice