Provider Demographics
NPI:1730591892
Name:10134 DENTAL PA
Entity type:Organization
Organization Name:10134 DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-561-8868
Mailing Address - Street 1:10134 HWY 6 SOUTH
Mailing Address - Street 2:SUITE 10134
Mailing Address - City:SUGARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4938
Mailing Address - Country:US
Mailing Address - Phone:281-561-8868
Mailing Address - Fax:
Practice Address - Street 1:10134 HWY 6 SOUTH
Practice Address - Street 2:SUITE 10134
Practice Address - City:SUGARLAND
Practice Address - State:TX
Practice Address - Zip Code:77498-4938
Practice Address - Country:US
Practice Address - Phone:281-561-8868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty