Provider Demographics
NPI:1477649689
Name:BRAR, AMANDEEP K (DDS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDEEP
Middle Name:K
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 1:5321 IRIS SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3302
Mailing Address - Country:US
Mailing Address - Phone:916-685-9119
Mailing Address - Fax:
Practice Address - Street 1:5756 PACIFIC AVE
Practice Address - Street 2:SUITE 75
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5160
Practice Address - Country:US
Practice Address - Phone:209-972-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52345122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist