Provider Demographics
NPI:1679630750
Name:CHANGELA, BHAVIN CHATRABHUJ (DDS)
Entity Type:Individual
Prefix:DR
First Name:BHAVIN
Middle Name:CHATRABHUJ
Last Name:CHANGELA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3280 CHINO HILLS PKWY
Mailing Address - Street 2:#4
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5865
Mailing Address - Country:US
Mailing Address - Phone:909-606-9907
Mailing Address - Fax:909-606-9945
Practice Address - Street 1:2407 VALLEY BLVD
Practice Address - Street 2:SUITE C-1
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2761
Practice Address - Country:US
Practice Address - Phone:909-839-1004
Practice Address - Fax:909-839-1017
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice