Provider Demographics
NPI:1528433935
Name:JATT DENTAL PC
Entity type:Organization
Organization Name:JATT DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-837-9431
Mailing Address - Street 1:1235 INDIAN TRAIL RD
Mailing Address - Street 2:SUITE#300
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-5524
Mailing Address - Country:US
Mailing Address - Phone:770-837-9431
Mailing Address - Fax:
Practice Address - Street 1:1235 INDIAN TRAIL RD
Practice Address - Street 2:SUITE#300
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5524
Practice Address - Country:US
Practice Address - Phone:770-837-9431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN012628OtherLICENCE