Provider Demographics
NPI:1629955570
Name:KAUR, ISHDEEP (DDS)
Entity type:Individual
Prefix:
First Name:ISHDEEP
Middle Name:
Last Name:KAUR
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 1:3629 BARTON ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8018
Mailing Address - Country:US
Mailing Address - Phone:408-614-8715
Mailing Address - Fax:
Practice Address - Street 1:2610 REYNOLDS RANCH PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6890
Practice Address - Country:US
Practice Address - Phone:408-614-8715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1120111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice