Provider Demographics
NPI:1497921977
Name:RASILA BHAKTA D.D.S.
Entity Type:Organization
Organization Name:RASILA BHAKTA D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RASILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-224-0170
Mailing Address - Street 1:1000 W CHOCTAW AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2260
Mailing Address - Country:US
Mailing Address - Phone:405-224-0170
Mailing Address - Fax:
Practice Address - Street 1:1000 W. CHOCTAW AVENUE
Practice Address - Street 2:SUITE 10
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2256
Practice Address - Country:US
Practice Address - Phone:405-224-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental