Provider Demographics
NPI:1356718175
Name:BRAR, NIRMALDEEP SINGH (DMD)
Entity type:Individual
Prefix:DR
First Name:NIRMALDEEP
Middle Name:SINGH
Last Name:BRAR
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 1:844 N CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1588
Mailing Address - Country:US
Mailing Address - Phone:847-660-8065
Mailing Address - Fax:219-924-7764
Practice Address - Street 1:844 N CLINE AVE
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-1588
Practice Address - Country:US
Practice Address - Phone:847-660-8065
Practice Address - Fax:219-924-7764
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030326122300000X
IN12012857A1223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty