Healthcare Provider Details

I. General information

NPI: 1013299189
Provider Name (Legal Business Name): GURVINDER SINGH BHATTI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NORTHEAST BLVD
CLINTON NC
28328-2424
US

IV. Provider business mailing address

730 VILLAGIO PL 428
FAYETTEVILLE NC
28303-4285
US

V. Phone/Fax

Practice location:
  • Phone: 252-991-6843
  • Fax:
Mailing address:
  • Phone: 559-907-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27405
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9631
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: