Provider Demographics
NPI:1316573785
Name:BAGGA, VANDEEP S (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:VANDEEP
Middle Name:S
Last Name:BAGGA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GREENE ST APT 2104
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07311-1443
Mailing Address - Country:US
Mailing Address - Phone:516-633-8368
Mailing Address - Fax:
Practice Address - Street 1:191 NORTH AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2438
Practice Address - Country:US
Practice Address - Phone:908-709-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027745001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty