Provider Demographics
NPI:1457937229
Name:BAKSH, KEMAL FEROZE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEMAL
Middle Name:FEROZE
Last Name:BAKSH
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 1:559TH MEDICAL SQUADRON
Mailing Address - Street 2:221 3RD STREET W
Mailing Address - City:RANDOLPH AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78150
Mailing Address - Country:US
Mailing Address - Phone:210-652-1846
Mailing Address - Fax:
Practice Address - Street 1:559TH MEDICAL SQUADRON
Practice Address - Street 2:221 3RD ST W
Practice Address - City:RANDOLPH AFB
Practice Address - State:TX
Practice Address - Zip Code:78150
Practice Address - Country:US
Practice Address - Phone:210-652-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014175471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice