Provider Demographics
NPI:1659881100
Name:BHULLAR, AMANDEEP (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDEEP
Middle Name:
Last Name:BHULLAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 WILLOW ST STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5101
Mailing Address - Country:US
Mailing Address - Phone:408-677-6811
Mailing Address - Fax:
Practice Address - Street 1:1660 WILLOW ST STE 7
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5101
Practice Address - Country:US
Practice Address - Phone:408-677-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553731223G0001X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral Practice