Provider Demographics
NPI:1003220740
Name:MAKANI, BHADRESH (DDS)
Entity Type:Individual
Prefix:
First Name:BHADRESH
Middle Name:
Last Name:MAKANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6957
Mailing Address - Country:US
Mailing Address - Phone:281-602-9373
Mailing Address - Fax:
Practice Address - Street 1:72 POTTSTOWN PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9564
Practice Address - Country:US
Practice Address - Phone:610-458-5165
Practice Address - Fax:610-514-2828
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist