Provider Demographics
NPI:1346243243
Name:BHAKTA, DHARMESH P (DPM)
Entity Type:Individual
Prefix:DR
First Name:DHARMESH
Middle Name:P
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:P
Other - Last Name:BHAKTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:3050 S CENTER ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2022
Mailing Address - Country:US
Mailing Address - Phone:817-557-1006
Mailing Address - Fax:817-557-2000
Practice Address - Street 1:3050 S CENTER ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2022
Practice Address - Country:US
Practice Address - Phone:817-557-1006
Practice Address - Fax:817-557-2000
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU91969Medicare UPIN
TX8457B9Medicare PIN
TX8D3572Medicare PIN