Provider Demographics
NPI:1174114177
Name:BRAR, SUKHMAN
Entity type:Individual
Prefix:
First Name:SUKHMAN
Middle Name:
Last Name:BRAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2601
Mailing Address - Country:US
Mailing Address - Phone:346-388-0505
Mailing Address - Fax:
Practice Address - Street 1:3701 SHAVER ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2601
Practice Address - Country:US
Practice Address - Phone:346-388-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty