Basic Information
| Provider Information | |||||||||
| NPI: | 1770864548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHULLAR | ||||||||
| FirstName: | HARVINDER | ||||||||
| MiddleName: | KAUR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 STONY POINT RD STE A | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954014121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075783118 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 140 STONY POINT RD STE A | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954014121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075783118 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2011 | ||||||||
| LastUpdateDate: | 11/29/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 056549 | NY | N | Dental Providers | Dentist | 1223D0001X | 056549 | NY | N | Dental Providers | Dentist | Dental Public Health | 1223G0001X | 056549 | NY | N | Dental Providers | Dentist | General Practice | 122300000X | DDS63495 | CA | Y | Dental Providers | Dentist |
No ID Information.