Provider Demographics
NPI:1053477117
Name:BAKHRU, DEEPAK H (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:H
Last Name:BAKHRU
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 1:1312 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1561
Mailing Address - Country:US
Mailing Address - Phone:518-798-2222
Mailing Address - Fax:
Practice Address - Street 1:1312 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1561
Practice Address - Country:US
Practice Address - Phone:518-798-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0349551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00576861Medicaid