Provider Demographics
NPI:1629270103
Name:GANTI, BHASKAR R (DDS)
Entity Type:Individual
Prefix:DR
First Name:BHASKAR
Middle Name:R
Last Name:GANTI
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 1:14220 FRANKLIN AVE
Mailing Address - Street 2:LH
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2640
Mailing Address - Country:US
Mailing Address - Phone:718-762-0880
Mailing Address - Fax:
Practice Address - Street 1:14220 FRANKLIN AVE
Practice Address - Street 2:LH
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2640
Practice Address - Country:US
Practice Address - Phone:718-762-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0391411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice