Provider Demographics
NPI:1376805556
Name:BRAR, PREMJEET KAUR (DDS)
Entity Type:Individual
Prefix:
First Name:PREMJEET
Middle Name:KAUR
Last Name:BRAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 PLEASANT GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6154
Mailing Address - Country:US
Mailing Address - Phone:916-783-5239
Mailing Address - Fax:
Practice Address - Street 1:721 PLEASANT GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6154
Practice Address - Country:US
Practice Address - Phone:916-783-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414116122300000X
390200000X
WA608528921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program