Provider Demographics
NPI:1659007631
Name:BHATT, SHAILJA (DDS)
Entity Type:Individual
Prefix:
First Name:SHAILJA
Middle Name:
Last Name:BHATT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HUALANI ST BLDG 9
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4378
Mailing Address - Country:US
Mailing Address - Phone:808-443-5204
Mailing Address - Fax:
Practice Address - Street 1:400 HUALANI ST STE 192
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4339
Practice Address - Country:US
Practice Address - Phone:808-443-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-3032-0122300000X
TN120061223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice