Provider Demographics
NPI:1669401766
Name:BHULLAR, RANDEEP SINGH (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDEEP
Middle Name:SINGH
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:BHULLAR DENTAL GROUP PC
Mailing Address - Street 2:1216 AVIATION BLVD. SUITE #101
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-718-9091
Mailing Address - Fax:770-718-9098
Practice Address - Street 1:1905 BEAVER RUIN RD STE 175
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3850
Practice Address - Country:US
Practice Address - Phone:770-728-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA549522689AMedicaid