Provider Demographics
NPI:1073071965
Name:BHULLAR, GAGANDEEP SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAGANDEEP
Middle Name:SINGH
Last Name:BHULLAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3178 COLLINS DR STE C
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3155
Mailing Address - Country:US
Mailing Address - Phone:209-259-6066
Mailing Address - Fax:
Practice Address - Street 1:3178 COLLINS DR STE C
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3155
Practice Address - Country:US
Practice Address - Phone:209-259-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1034181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice