Provider Demographics
NPI:1891943346
Name:BHULLAR DENTAL GROUP,PC
Entity Type:Organization
Organization Name:BHULLAR DENTAL GROUP,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-718-9091
Mailing Address - Street 1:1216 AVIATION BLVD
Mailing Address - Street 2:SUITE#101
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-6848
Mailing Address - Country:US
Mailing Address - Phone:770-718-9091
Mailing Address - Fax:
Practice Address - Street 1:1216 AVIATION BLVD
Practice Address - Street 2:SUITE#101
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-6848
Practice Address - Country:US
Practice Address - Phone:770-718-9091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112965OtherDORAL DENTAL
GA549522689NMedicaid