Healthcare Provider Details

I. General information

NPI: 1104685999
Provider Name (Legal Business Name): RAJWANT KAUR BHATTI DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 EAST ST STE 270
CONCORD CA
94520-2066
US

IV. Provider business mailing address

4639 MARGARET ADELE LN
TRACY CA
95377-8865
US

V. Phone/Fax

Practice location:
  • Phone: 206-866-4289
  • Fax:
Mailing address:
  • Phone: 206-866-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAJWANT KAUR SANGHA
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 206-866-4289