Provider Demographics
NPI:1295387421
Name:BHATIA, SACHAN
Entity Type:Individual
Prefix:
First Name:SACHAN
Middle Name:
Last Name:BHATIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-4304
Mailing Address - Country:US
Mailing Address - Phone:715-544-6100
Mailing Address - Fax:
Practice Address - Street 1:1819 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-4304
Practice Address - Country:US
Practice Address - Phone:715-544-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002135-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist