Provider Demographics
NPI:1033439823
Name:BHAKTA, PAAYAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAAYAL
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23320 N STATE ROAD 235
Mailing Address - Street 2:
Mailing Address - City:BROOKER
Mailing Address - State:FL
Mailing Address - Zip Code:32622-5266
Mailing Address - Country:US
Mailing Address - Phone:352-485-1133
Mailing Address - Fax:352-485-1961
Practice Address - Street 1:23320 N STATE ROAD 235
Practice Address - Street 2:
Practice Address - City:BROOKER
Practice Address - State:FL
Practice Address - Zip Code:32622-5266
Practice Address - Country:US
Practice Address - Phone:352-485-1133
Practice Address - Fax:352-485-1961
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist