Healthcare Provider Details

I. General information

NPI: 1235841610
Provider Name (Legal Business Name): AMARJOT BRAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 STATE RD
DREXEL HILL PA
19026-4423
US

IV. Provider business mailing address

923 TURNER AVE
DREXEL HILL PA
19026-1727
US

V. Phone/Fax

Practice location:
  • Phone: 610-200-9200
  • Fax:
Mailing address:
  • Phone: 201-785-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045243
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: