Provider Demographics
NPI:1033093620
Name:PERVEZ, KIRAN
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:PERVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIRAN
Other - Middle Name:
Other - Last Name:PERVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KIRAN PERVEZ
Mailing Address - Street 1:122 E CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4420
Mailing Address - Country:US
Mailing Address - Phone:502-919-3115
Mailing Address - Fax:
Practice Address - Street 1:188 CHASE AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-2245
Practice Address - Country:US
Practice Address - Phone:203-754-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist