Provider Demographics
NPI:1790071769
Name:BAFNA, RISHI (DMD)
Entity Type:Individual
Prefix:
First Name:RISHI
Middle Name:
Last Name:BAFNA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 STATE HIGHWAY 121 STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5204
Mailing Address - Country:US
Mailing Address - Phone:469-333-3300
Mailing Address - Fax:
Practice Address - Street 1:3680 STATE HIGHWAY 121 STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-5204
Practice Address - Country:US
Practice Address - Phone:469-333-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice