Provider Demographics
NPI:1902247679
Name:BHUVA, KEVIN R
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:BHUVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 ALTAMESA BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5773
Mailing Address - Country:US
Mailing Address - Phone:817-361-8111
Mailing Address - Fax:
Practice Address - Street 1:3401 ALTAMESA BLVD STE 128
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5773
Practice Address - Country:US
Practice Address - Phone:817-361-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist