Provider Demographics
NPI:1306228986
Name:BHAKTA, KUNAL DHARMENDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KUNAL
Middle Name:DHARMENDRA
Last Name:BHAKTA
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 1:7005 N CHESTNUT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0348
Mailing Address - Country:US
Mailing Address - Phone:714-717-5378
Mailing Address - Fax:
Practice Address - Street 1:7005 N CHESTNUT AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0348
Practice Address - Country:US
Practice Address - Phone:714-717-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1004481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid