Provider Demographics
NPI:1073000139
Name:BHANGRA, GURSIMRAN KAUR
Entity Type:Individual
Prefix:
First Name:GURSIMRAN
Middle Name:KAUR
Last Name:BHANGRA
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 1:42201 DOVE WING CT
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-8092
Mailing Address - Country:US
Mailing Address - Phone:703-585-5236
Mailing Address - Fax:
Practice Address - Street 1:8140 STONEWALL SHOPS SQ
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3891
Practice Address - Country:US
Practice Address - Phone:571-298-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist