Healthcare Provider Details

I. General information

NPI: 1083202600
Provider Name (Legal Business Name): BUMBLE KIDS PEDIATRIC DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E MAIN ST
WESTFIELD IN
46074-9440
US

IV. Provider business mailing address

260 WOOD MOOR PL
COLUMBIA SC
29212-2712
US

V. Phone/Fax

Practice location:
  • Phone: 803-429-7401
  • Fax:
Mailing address:
  • Phone: 803-429-7401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SUKHVINDER KAUR GURAM
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 803-429-7401