Provider Demographics
NPI:1598373243
Name:BHARMAL, UMAIMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:UMAIMA
Middle Name:
Last Name:BHARMAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:UMAIMA
Other - Middle Name:
Other - Last Name:SUTERIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5825 LOS CIENTOS CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3421
Mailing Address - Country:US
Mailing Address - Phone:936-577-0063
Mailing Address - Fax:
Practice Address - Street 1:424 S MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3828
Practice Address - Country:US
Practice Address - Phone:714-881-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104962OtherCALIFORNIA DENTAL BOARD LICENSE NUMBER