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General NPI Number Information
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NPI Number | 1609300722
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Entity Type | Individual
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Provider Name | CHAMANDEEP BRAR
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Gender | Male
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 11092 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92350-1706
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Country | US
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Telephone | 909-558-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 132 NEWBRIDGE CRES
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City | BRAMPTON
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State | ONTARIO
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Zip | L6S4B3
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Country | CA
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Telephone |
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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 | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 36031
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License Number State | TX
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