Provider Demographics
NPI:1083729040
Name:BHAKTA, AMIT (DMD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11540 DOWNEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-869-3578
Mailing Address - Fax:714-761-0145
Practice Address - Street 1:11540 DOWNEY AVENUE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-869-3578
Practice Address - Fax:714-761-0145
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159776701Medicaid