Provider Demographics
NPI:1184398802
Name:POONI, GURSIMRAT K
Entity type:Individual
Prefix:
First Name:GURSIMRAT
Middle Name:K
Last Name:POONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 KENIA CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3738
Mailing Address - Country:US
Mailing Address - Phone:951-440-5993
Mailing Address - Fax:909-803-9309
Practice Address - Street 1:6626 KENIA CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3738
Practice Address - Country:US
Practice Address - Phone:951-440-5993
Practice Address - Fax:909-803-9309
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist