MEDICARE: ADITYA BHAWSAR BDS, MDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	32035	TX
2	1223P0700X	Prosthodontics	32035	TX

General Provider Information

NPI Number	:	1457802944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADITYA BHAWSAR BDS, MDS

Provider Business Mailing Address
First Line	:	4109 HOUSTON HWY STE 200
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-4700
Country	:	US
Telephone Number	:	361-360-6010
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 HOUSTON HWY STE 200
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-4700
Country	:	US
Telephone Number	:	361-360-6010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2016
Last Update Date	:	10/19/2016

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