Provider Demographics
NPI:1053821413
Name:BHATT, DHELNI TUSHAR (DMD)
Entity Type:Individual
Prefix:
First Name:DHELNI
Middle Name:TUSHAR
Last Name:BHATT
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 1:3561 W CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-1223
Mailing Address - Country:US
Mailing Address - Phone:323-483-7042
Mailing Address - Fax:
Practice Address - Street 1:3561 W CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-1223
Practice Address - Country:US
Practice Address - Phone:323-483-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10016961223G0001X
CA104361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice