Provider Demographics
NPI:1639805781
Name:BHAVAN, KALIN JEETESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KALIN
Middle Name:JEETESH
Last Name:BHAVAN
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 1:2529 CIMA HILL DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4765
Mailing Address - Country:US
Mailing Address - Phone:214-562-7068
Mailing Address - Fax:
Practice Address - Street 1:2515 E ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3708
Practice Address - Country:US
Practice Address - Phone:940-696-9702
Practice Address - Fax:940-691-8425
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX387891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice