Healthcare Provider Details

I. General information

NPI: 1952491011
Provider Name (Legal Business Name): AMANBIR BRAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 W SHAW AVE SUITE 103
FRESNO CA
93711-3315
US

IV. Provider business mailing address

4438 MENLO AVE APT 1
SAN DIEGO CA
92115-4433
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-2900
  • Fax:
Mailing address:
  • Phone: 619-757-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: