Provider Demographics
NPI:1386110534
Name:AMAN BHULLAR DMD,INC
Entity type:Organization
Organization Name:AMAN BHULLAR DMD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:BHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-677-6811
Mailing Address - Street 1:1660 WILLOW ST STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5101
Mailing Address - Country:US
Mailing Address - Phone:408-266-4571
Mailing Address - Fax:408-267-9016
Practice Address - Street 1:1660 WILLOW ST STE 7
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5101
Practice Address - Country:US
Practice Address - Phone:408-266-4571
Practice Address - Fax:408-267-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55373OtherDENTAL LICENCE