Provider Demographics
NPI:1396369807
Name:BHAVIK BHAKTA DDS INC
Entity Type:Organization
Organization Name:BHAVIK BHAKTA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHAVIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-528-2771
Mailing Address - Street 1:4360 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1232
Mailing Address - Country:US
Mailing Address - Phone:323-528-2771
Mailing Address - Fax:
Practice Address - Street 1:770 MAGNOLIA AVE STE 1A
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3121
Practice Address - Country:US
Practice Address - Phone:951-371-1337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental