Provider Demographics
NPI:1336651587
Name:BHULLAR, YADVINDER SINGH
Entity Type:Individual
Prefix:
First Name:YADVINDER SINGH
Middle Name:
Last Name:BHULLAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 EL PORTAL DR APT H110
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2782
Mailing Address - Country:US
Mailing Address - Phone:925-963-6471
Mailing Address - Fax:
Practice Address - Street 1:1208 FITZGERALD DR
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2252
Practice Address - Country:US
Practice Address - Phone:510-210-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA102018OtherDENTAL BOARD OF CALIFORNIA