Provider Demographics
NPI:1093193484
Name:BHAGAVATULA, GARGI (DDS)
Entity type:Individual
Prefix:DR
First Name:GARGI
Middle Name:
Last Name:BHAGAVATULA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 CHAPEL ST APT 546
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3163
Mailing Address - Country:US
Mailing Address - Phone:402-213-6077
Mailing Address - Fax:
Practice Address - Street 1:123 YORK ST STE 4L
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5665
Practice Address - Country:US
Practice Address - Phone:203-781-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10010311223G0001X
CT135931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice