Provider Demographics
NPI:1669670881
Name:BHAN, PAYAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:
Last Name:BHAN
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 1:2009 LAZY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7858
Mailing Address - Country:US
Mailing Address - Phone:912-281-1849
Mailing Address - Fax:
Practice Address - Street 1:2009 LAZY LAKE DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7858
Practice Address - Country:US
Practice Address - Phone:912-281-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice