Provider Demographics
NPI:1104012269
Name:A.R.BHAGWANDASS.DMD.PA
Entity Type:Organization
Organization Name:A.R.BHAGWANDASS.DMD.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISHWAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:BHAGWANDASS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:252-537-4141
Mailing Address - Street 1:50 ANNA LOUISE LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-8648
Mailing Address - Country:US
Mailing Address - Phone:252-537-4141
Mailing Address - Fax:252-537-7520
Practice Address - Street 1:50 ANNA LOUISE LN
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-8648
Practice Address - Country:US
Practice Address - Phone:252-537-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5794261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990719Medicaid