Provider Demographics
NPI:1083263727
Name:BHAVSAR, SAYALI S (DDS)
Entity Type:Individual
Prefix:
First Name:SAYALI
Middle Name:S
Last Name:BHAVSAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 LAGUNA AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3563
Mailing Address - Country:US
Mailing Address - Phone:949-527-2599
Mailing Address - Fax:
Practice Address - Street 1:1117 LAGUNA AVE APT 5
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3563
Practice Address - Country:US
Practice Address - Phone:949-527-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS104354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist