Provider Demographics
NPI:1225031214
Name:BHANOT, DEEPALI MEHTA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEEPALI
Middle Name:MEHTA
Last Name:BHANOT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:DEEPALI
Other - Middle Name:
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20400 OBSERVATION DR
Mailing Address - Street 2:# 208
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4085
Mailing Address - Country:US
Mailing Address - Phone:301-528-8685
Mailing Address - Fax:301-528-2051
Practice Address - Street 1:20400 OBSERVATION DR
Practice Address - Street 2:# 208
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4085
Practice Address - Country:US
Practice Address - Phone:301-528-8685
Practice Address - Fax:301-528-2051
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid