Provider Demographics
NPI:1558938753
Name:BAJWA, AMIT SINGH (DDS)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:SINGH
Last Name:BAJWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:AMIT
Other - Middle Name:
Other - Last Name:RAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1324 HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2408
Mailing Address - Country:US
Mailing Address - Phone:321-773-6666
Mailing Address - Fax:
Practice Address - Street 1:1324 HIGHWAY A1A
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2408
Practice Address - Country:US
Practice Address - Phone:321-773-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist