Provider Demographics
NPI:1861878498
Name:KAMBOJ, KARANJIT SINGH (DDS)
Entity type:Individual
Prefix:DR
First Name:KARANJIT
Middle Name:SINGH
Last Name:KAMBOJ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 KISSENA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2950
Mailing Address - Country:US
Mailing Address - Phone:718-305-4567
Mailing Address - Fax:718-306-9471
Practice Address - Street 1:4343 KISSENA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-305-4567
Practice Address - Fax:718-306-9471
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0581341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04376972Medicaid