Provider Demographics
NPI:1013407246
Name:NIRMALDEEP SINGH BRAR DMD LLC
Entity Type:Organization
Organization Name:NIRMALDEEP SINGH BRAR DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRMALDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:219-924-7733
Mailing Address - Street 1:844 N CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1588
Mailing Address - Country:US
Mailing Address - Phone:219-924-7733
Mailing Address - Fax:
Practice Address - Street 1:844 N CLINE AVE STE 2N
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319
Practice Address - Country:US
Practice Address - Phone:219-924-7733
Practice Address - Fax:219-924-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012857A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty