Provider Demographics
NPI:1366503211
Name:BHARGAVA DDS PA
Entity Type:Organization
Organization Name:BHARGAVA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARGAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-630-0002
Mailing Address - Street 1:1230 N BROADMOOR AVE
Mailing Address - Street 2:STE # 300
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3891
Mailing Address - Country:US
Mailing Address - Phone:316-630-0002
Mailing Address - Fax:316-630-0004
Practice Address - Street 1:1230 N BROADMOOR AVE
Practice Address - Street 2:STE # 300
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3891
Practice Address - Country:US
Practice Address - Phone:316-630-0002
Practice Address - Fax:316-630-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS601811223G0001X
KS601821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty