Healthcare Provider Details

I. General information

NPI: 1386752459
Provider Name (Legal Business Name): JHUJHAR BHAMBRA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CANAL LANDING BLVD SUITE 10
ROCHESTER NY
14626-5105
US

IV. Provider business mailing address

105 CANAL LANDING BLVD SUITE 10
ROCHESTER NY
14626-5105
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-3636
  • Fax: 585-723-8365
Mailing address:
  • Phone: 585-723-3636
  • Fax: 585-723-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number049465-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: