Provider Demographics
NPI:1750487328
Name:BHATT, SHAILESHKUMAR M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAILESHKUMAR
Middle Name:M
Last Name:BHATT
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 1:450 S GLENDORA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3066
Mailing Address - Country:US
Mailing Address - Phone:626-856-3317
Mailing Address - Fax:626-856-5553
Practice Address - Street 1:450 S GLENDORA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3066
Practice Address - Country:US
Practice Address - Phone:626-856-3317
Practice Address - Fax:626-856-5553
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice