Provider Demographics
NPI:1073012639
Name:GEORGIA DENTURES AND IMPLANTS PC
Entity Type:Organization
Organization Name:GEORGIA DENTURES AND IMPLANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-728-8072
Mailing Address - Street 1:1905 BEAVER RUIN RD STE 175
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-3850
Mailing Address - Country:US
Mailing Address - Phone:770-728-8072
Mailing Address - Fax:
Practice Address - Street 1:1905 BEAVER RUIN RD STE 175
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3850
Practice Address - Country:US
Practice Address - Phone:770-728-8072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012628261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental