Provider Demographics
NPI:1043833395
Name:KALRA, RAVNEET KAUR (DDS)
Entity type:Individual
Prefix:DR
First Name:RAVNEET
Middle Name:KAUR
Last Name:KALRA
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 1:5226 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5076
Mailing Address - Country:US
Mailing Address - Phone:571-341-0957
Mailing Address - Fax:
Practice Address - Street 1:13955 INTERURBAN AVE S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4701
Practice Address - Country:US
Practice Address - Phone:206-431-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61276613122300000X, 1223G0001X
VA04014170091223G0001X
DCDEN10021341223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program