Provider Demographics
NPI:1437360211
Name:DEBORAH BHASKER PC
Entity Type:Organization
Organization Name:DEBORAH BHASKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BHASKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-856-3313
Mailing Address - Street 1:24297 VALLEY VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413-8333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 SE GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CEDAREDGE
Practice Address - State:CO
Practice Address - Zip Code:81413-4003
Practice Address - Country:US
Practice Address - Phone:970-856-3313
Practice Address - Fax:970-856-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22627Medicaid