Provider Demographics
NPI:1639326523
Name:BHATLA, SHEENAM (DMD)
Entity Type:Individual
Prefix:
First Name:SHEENAM
Middle Name:
Last Name:BHATLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PONDS EDGE DR
Mailing Address - Street 2:SUITE# 2
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9389
Mailing Address - Country:US
Mailing Address - Phone:610-388-4466
Mailing Address - Fax:610-388-5808
Practice Address - Street 1:8 PONDS EDGE DR
Practice Address - Street 2:SUITE# 2
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9389
Practice Address - Country:US
Practice Address - Phone:610-388-4466
Practice Address - Fax:610-388-5808
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0375011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice