Provider Demographics
NPI:1558934422
Name:BHAKTA, JAY PRAFUL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:PRAFUL
Last Name:BHAKTA
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 1:22510 IH 35 STE 104
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6688
Mailing Address - Country:US
Mailing Address - Phone:512-888-9340
Mailing Address - Fax:
Practice Address - Street 1:22510 IH 35 STE 104
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6688
Practice Address - Country:US
Practice Address - Phone:512-888-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61822122300000X
TX38172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist