Healthcare Provider Details

I. General information

NPI: 1760663413
Provider Name (Legal Business Name): VIKRAM BRAR DDS,MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 COFFEE RD SUITE 1B
MODESTO CA
95355-4228
US

IV. Provider business mailing address

1130 COFFEE ROAD SUITE 1B
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-527-2300
  • Fax: 209-527-2332
Mailing address:
  • Phone: 209-527-2300
  • Fax: 209-527-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number43761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: