Provider Demographics
NPI:1609948645
Name:BRAHMBHATT, MITESH GIRISHKUMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITESH
Middle Name:GIRISHKUMAR
Last Name:BRAHMBHATT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3886 BEMISS RD STE C
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6125
Mailing Address - Country:US
Mailing Address - Phone:229-469-8492
Mailing Address - Fax:229-469-5259
Practice Address - Street 1:3886 BEMISS RD STE C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6125
Practice Address - Country:US
Practice Address - Phone:229-469-8492
Practice Address - Fax:229-469-5259
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013655122300000X, 122300000X
MA22114122300000X
PADS037033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist