Provider Demographics
NPI:1336623842
Name:MAKWANA, BHAVIK JAYSUKHBHAI (DDS)
Entity Type:Individual
Prefix:
First Name:BHAVIK
Middle Name:JAYSUKHBHAI
Last Name:MAKWANA
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 1:2901 CITYPLACE WEST BLVD APT 622
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-0362
Mailing Address - Country:US
Mailing Address - Phone:267-460-3115
Mailing Address - Fax:
Practice Address - Street 1:104 W CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3327
Practice Address - Country:US
Practice Address - Phone:214-253-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist