Provider Demographics
NPI:1447392964
Name:BHATT, BHARAT C (DDS)
Entity Type:Individual
Prefix:
First Name:BHARAT
Middle Name:C
Last Name:BHATT
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 1:6081 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-3012
Mailing Address - Country:US
Mailing Address - Phone:562-422-6003
Mailing Address - Fax:562-422-6003
Practice Address - Street 1:6081 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-3012
Practice Address - Country:US
Practice Address - Phone:562-422-6003
Practice Address - Fax:562-422-6003
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD28906122300000X
CAB289061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice