Provider Demographics
NPI:1386752459
Name:BHAMBRA, JHUJHAR (DMD)
Entity type:Individual
Prefix:
First Name:JHUJHAR
Middle Name:
Last Name:BHAMBRA
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 1:105 CANAL LANDING BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5105
Mailing Address - Country:US
Mailing Address - Phone:585-723-3636
Mailing Address - Fax:585-723-8365
Practice Address - Street 1:105 CANAL LANDING BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5105
Practice Address - Country:US
Practice Address - Phone:585-723-3636
Practice Address - Fax:585-723-8365
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049465-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0204455Medicaid
MAX10762OtherBLUE CROSS BLUE SHIELD