Provider Demographics
NPI:1528318508
Name:REACH DENTAL PC
Entity type:Organization
Organization Name:REACH DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-277-5588
Mailing Address - Street 1:845 SCENIC HWY
Mailing Address - Street 2:SUITE#300
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7101
Mailing Address - Country:US
Mailing Address - Phone:770-277-5588
Mailing Address - Fax:
Practice Address - Street 1:845 SCENIC HWY
Practice Address - Street 2:SUITE#300
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7101
Practice Address - Country:US
Practice Address - Phone:770-277-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA549522689AMedicaid