Provider Demographics
NPI:1245534395
Name:BHAVNAGRI, FAWZIA (DDS)
Entity type:Individual
Prefix:
First Name:FAWZIA
Middle Name:
Last Name:BHAVNAGRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SALEM AVE SW
Mailing Address - Street 2:UNIT 2M
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-3631
Mailing Address - Country:US
Mailing Address - Phone:804-513-4012
Mailing Address - Fax:
Practice Address - Street 1:601 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3142
Practice Address - Country:US
Practice Address - Phone:540-382-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413064122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist