Provider Demographics
NPI:1083202600
Name:BUMBLE KIDS PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:BUMBLE KIDS PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKHVINDER
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:GURAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-429-7401
Mailing Address - Street 1:260 WOOD MOOR PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2712
Mailing Address - Country:US
Mailing Address - Phone:803-429-7401
Mailing Address - Fax:
Practice Address - Street 1:715 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9440
Practice Address - Country:US
Practice Address - Phone:803-429-7401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty