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General NPI Number Information
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NPI Number | 1528433935
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Entity Type | Organization
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Legal Business Name | JATT DENTAL PC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 1235 INDIAN TRAIL RD SUITE#300
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City | NORCROSS
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State | GA
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Zip | 30093-5524
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Country | US
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Telephone | 770-837-9431
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 INDIAN TRAIL RD SUITE#300
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City | NORCROSS
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State | GA
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Zip | 30093-5524
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Country | US
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Telephone | 770-837-9431
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDEEP S BHULLAR
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Credential | DDS
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Telephone | 770-837-9431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN012628
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License Number State | GA
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