Provider Demographics
NPI:1205019056
Name:BHATIA, TARAN (DDS)
Entity Type:Individual
Prefix:
First Name:TARAN
Middle Name:
Last Name:BHATIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TARAN
Other - Middle Name:
Other - Last Name:BHATIA-MEHROTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3809 S GENERAL BRUCE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502
Mailing Address - Country:US
Mailing Address - Phone:254-778-3384
Mailing Address - Fax:254-699-3465
Practice Address - Street 1:3809 S GENERAL BRUCE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502
Practice Address - Country:US
Practice Address - Phone:254-778-3384
Practice Address - Fax:254-699-3465
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162996603Medicaid