Provider Demographics
NPI:1043928013
Name:KANSAGRA, YASH RASHMIKANT (DMD)
Entity type:Individual
Prefix:
First Name:YASH
Middle Name:RASHMIKANT
Last Name:KANSAGRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3001
Mailing Address - Country:US
Mailing Address - Phone:610-434-3310
Mailing Address - Fax:610-434-4270
Practice Address - Street 1:1111 N 19TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-3001
Practice Address - Country:US
Practice Address - Phone:610-434-3310
Practice Address - Fax:610-434-4270
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0439131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice