Provider Demographics
NPI:1407800964
Name:BHAGAT, RAJIV (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:BHAGAT
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 1:10447 VIVIENDA ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-1755
Mailing Address - Country:US
Mailing Address - Phone:909-941-6448
Mailing Address - Fax:
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3100
Practice Address - Country:US
Practice Address - Phone:951-736-0603
Practice Address - Fax:951-736-0698
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA354711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics