Provider Demographics
NPI:1609606185
Name:MAPLE DENTAL DDS PC
Entity type:Organization
Organization Name:MAPLE DENTAL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GURPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-445-3453
Mailing Address - Street 1:14207 KIDD CREEK CROSSOVER
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-0180
Mailing Address - Country:US
Mailing Address - Phone:216-801-2718
Mailing Address - Fax:
Practice Address - Street 1:6418 EST STATE BOULEVARD
Practice Address - Street 2:STORE #23
Practice Address - City:FORTWAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815
Practice Address - Country:US
Practice Address - Phone:347-445-3453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental