Provider Demographics
NPI:1225358161
Name:BHOLAT, NAZNIN S (DDS)
Entity Type:Individual
Prefix:
First Name:NAZNIN
Middle Name:S
Last Name:BHOLAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31581 CANYON ESTATES DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0412
Mailing Address - Country:US
Mailing Address - Phone:951-579-1010
Mailing Address - Fax:951-579-1006
Practice Address - Street 1:31581 CANYON ESTATES DR STE 201
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0412
Practice Address - Country:US
Practice Address - Phone:951-579-1010
Practice Address - Fax:951-579-1006
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891114609Medicaid