Healthcare Provider Details

I. General information

NPI: 1558938753
Provider Name (Legal Business Name): AMIT SINGH BAJWA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AMIT RAM

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 OLD SALEM RD SE
CONYERS GA
30094-5944
US

IV. Provider business mailing address

1152 OLD SALEM RD SE
CONYERS GA
30094-5944
US

V. Phone/Fax

Practice location:
  • Phone: 678-233-2973
  • Fax:
Mailing address:
  • Phone: 321-773-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN25894
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124346
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: