Healthcare Provider Details

I. General information

NPI: 1396086575
Provider Name (Legal Business Name): KANWAR SINGH BHOGAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 N 3RD ST
PHOENIX AZ
85020-2444
US

IV. Provider business mailing address

7500 N DREAMY DRAW DR STE 145
PHOENIX AZ
85020-4668
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4545
  • Fax: 602-714-3755
Mailing address:
  • Phone: 480-882-4545
  • Fax: 602-409-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD8658
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD008658
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: