Hermon Singh Bhullar, DDS
Individual provider Active NPI Endodontics · Hercules, CA
NPI 1346474087 · NPPES record last updated Jul 22, 2013
Key facts
- NPI
- 1346474087
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 51897 (CA)
- Practice address
- 500 Alfred Nobel Dr Ste 205
Hercules, CA 94547-1840 - Phone
- (510) 964-7219
- Fax
- (510) 964-7251
- NPI assigned
- May 10, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160428001154 | CA | Order and Referring Only - Dentist |
5890094650 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 054166 | NY | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hermonpal S Bhullar DDS Inc | Endodontics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 054166 | NY | |
| Endodontics | 1223E0200X | 51897 | CA | Yes |
Addresses
Primary practice location
500 Alfred Nobel Dr Ste 205
Hercules, CA 94547-1840
Mailing address
500 Alfred Nobel Dr Ste 205
Hercules, CA 94547-1840
Phone (510) 964-7219
Other names
- Hermonpal S Bhullar DDS Inc
Other providers in Hercules, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.