Provider Demographics
NPI:1720200447
Name:S M BHATT DDS INC
Entity Type:Organization
Organization Name:S M BHATT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILESHKUMAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-856-3317
Mailing Address - Street 1:450 S GLENDORA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3066
Mailing Address - Country:US
Mailing Address - Phone:626-856-3317
Mailing Address - Fax:626-856-5553
Practice Address - Street 1:450 S GLENDORA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3066
Practice Address - Country:US
Practice Address - Phone:626-856-3317
Practice Address - Fax:626-856-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty