Provider Demographics
NPI:1952811218
Name:BHOGAL, EKTA SEM (DMD)
Entity Type:Individual
Prefix:
First Name:EKTA
Middle Name:SEM
Last Name:BHOGAL
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 1:99 GORGE RD APT 2304
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1730
Mailing Address - Country:US
Mailing Address - Phone:610-888-2558
Mailing Address - Fax:
Practice Address - Street 1:500 S RIVER ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6651
Practice Address - Country:US
Practice Address - Phone:201-641-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-01
Last Update Date:2017-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI026914001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice