Provider Demographics
NPI:1083871651
Name:BHATIA, SANJEEV R (DDS)
Entity Type:Individual
Prefix:
First Name:SANJEEV
Middle Name:R
Last Name:BHATIA
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 1:4 DASKAM LN
Mailing Address - Street 2:#115
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4845
Mailing Address - Country:US
Mailing Address - Phone:203-559-1025
Mailing Address - Fax:
Practice Address - Street 1:4 DASKAM LN
Practice Address - Street 2:#115
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4845
Practice Address - Country:US
Practice Address - Phone:203-559-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009360122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist