Provider Demographics
NPI:1780351817
Name:BHANDARKAR, KIRAN SRINIVAS (DDS)
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:SRINIVAS
Last Name:BHANDARKAR
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 1:200 SE AVENUE G APT 211
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-5185
Mailing Address - Country:US
Mailing Address - Phone:817-687-8067
Mailing Address - Fax:
Practice Address - Street 1:705 HOBBS HWY
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360
Practice Address - Country:US
Practice Address - Phone:432-245-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice