Provider Demographics
NPI:1649321720
Name:BAVISHI, NAMRATA SANJIV (DMD)
Entity type:Individual
Prefix:DR
First Name:NAMRATA
Middle Name:SANJIV
Last Name:BAVISHI
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 1:287 NOB HILL DR
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-2433
Mailing Address - Country:US
Mailing Address - Phone:914-347-4745
Mailing Address - Fax:
Practice Address - Street 1:38 BEEKMAN AVE
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2666
Practice Address - Country:US
Practice Address - Phone:914-631-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50-052544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02729404Medicaid