Provider Demographics
NPI:1740604222
Name:BHARAL, POONUM
Entity Type:Individual
Prefix:
First Name:POONUM
Middle Name:
Last Name:BHARAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 HARBOUR VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6559
Mailing Address - Country:US
Mailing Address - Phone:804-739-6500
Mailing Address - Fax:
Practice Address - Street 1:6510 HARBOUR VIEW CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-6559
Practice Address - Country:US
Practice Address - Phone:804-739-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412852122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist