Provider Demographics
NPI:1184740441
Name:BHARGAVA, DIVYA (DMD)
Entity type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:BHARGAVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 TEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7010
Mailing Address - Country:US
Mailing Address - Phone:781-492-8429
Mailing Address - Fax:
Practice Address - Street 1:39 BROADWAY
Practice Address - Street 2:#2115
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3003
Practice Address - Country:US
Practice Address - Phone:212-422-9229
Practice Address - Fax:212-742-0928
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty