Provider Demographics
NPI:1932254935
Name:BHATTAL, BHUPINDER S (DDS)
Entity Type:Individual
Prefix:DR
First Name:BHUPINDER
Middle Name:S
Last Name:BHATTAL
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 1:592 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4035
Mailing Address - Country:US
Mailing Address - Phone:518-783-2233
Mailing Address - Fax:518-783-2244
Practice Address - Street 1:592 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4035
Practice Address - Country:US
Practice Address - Phone:518-783-2233
Practice Address - Fax:518-783-2244
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049797-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice