Provider Demographics
NPI:1083017172
Name:BHARGAVA, PRAGATI
Entity Type:Individual
Prefix:DR
First Name:PRAGATI
Middle Name:
Last Name:BHARGAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 LOCUST ST
Mailing Address - Street 2:APT # 209
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5252
Mailing Address - Country:US
Mailing Address - Phone:810-335-2777
Mailing Address - Fax:
Practice Address - Street 1:240 S 40TH ST # 122
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-6030
Practice Address - Country:US
Practice Address - Phone:810-335-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist