Provider Demographics
NPI:1265735542
Name:BHULLAR, HARBIR (DDS)
Entity type:Individual
Prefix:DR
First Name:HARBIR
Middle Name:
Last Name:BHULLAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 WAGON TRAIN LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3647
Mailing Address - Country:US
Mailing Address - Phone:951-751-1919
Mailing Address - Fax:
Practice Address - Street 1:12821 MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-9127
Practice Address - Country:US
Practice Address - Phone:760-947-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50054647122300000X
CA620701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist