Provider Demographics
NPI:1932259132
Name:BHAKTA, GIAO TON (DMD)
Entity Type:Individual
Prefix:
First Name:GIAO
Middle Name:TON
Last Name:BHAKTA
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 1:2550 TUSCANY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4660
Mailing Address - Country:US
Mailing Address - Phone:951-280-9073
Mailing Address - Fax:
Practice Address - Street 1:2550 TUSCANY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4660
Practice Address - Country:US
Practice Address - Phone:951-280-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice