Provider Demographics
NPI:1780855973
Name:BHAT DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:BHAT DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARAYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-289-2122
Mailing Address - Street 1:590 EAGLES LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7236
Mailing Address - Country:US
Mailing Address - Phone:678-289-2122
Mailing Address - Fax:678-289-2121
Practice Address - Street 1:590 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7236
Practice Address - Country:US
Practice Address - Phone:678-289-2122
Practice Address - Fax:678-289-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129391223G0001X
GADN0129401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1925468OtherUNITED CONCORDIA
GA757245258AMedicaid