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General NPI Number Information
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NPI Number | 1316573785
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Entity Type | Individual
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Provider Name | VANDEEP S BAGGA DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 191 NORTH AVE E
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City | CRANFORD
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State | NJ
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Zip | 07016-2438
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Country | US
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Telephone | 908-709-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 200 GREENE ST APT 2104
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City | JERSEY CITY
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State | NJ
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Zip | 07311-1443
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Country | US
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Telephone | 516-633-8368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI02774500
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License Number State | NJ
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