Provider Demographics
NPI:1154475499
Name:BHAT, ISHWARANAND G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISHWARANAND
Middle Name:G
Last Name:BHAT
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 1:300 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17053-1221
Mailing Address - Country:US
Mailing Address - Phone:717-957-3711
Mailing Address - Fax:717-957-4583
Practice Address - Street 1:300 S STATE RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17053-1221
Practice Address - Country:US
Practice Address - Phone:717-957-3711
Practice Address - Fax:717-957-4583
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020219-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005161980001Medicaid