Provider Demographics
NPI:1780858688
Name:BHAKTA, BHAVESH B (DDS)
Entity type:Individual
Prefix:
First Name:BHAVESH
Middle Name:B
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 1:105 AZIMUTH DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4953
Mailing Address - Country:US
Mailing Address - Phone:512-825-9921
Mailing Address - Fax:512-519-7704
Practice Address - Street 1:201 E WILCO HWY STE 203
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-2739
Practice Address - Country:US
Practice Address - Phone:512-599-0200
Practice Address - Fax:512-519-7704
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice