Healthcare Provider Details

I. General information

NPI: 1962688903
Provider Name (Legal Business Name): VIHAR BHAKTA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2008
Last Update Date: 01/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10907 ATLANTIC AVE
LYNWOOD CA
90262-2310
US

IV. Provider business mailing address

10907 ATLANTIC AVE
LYNWOOD CA
90262-2310
US

V. Phone/Fax

Practice location:
  • Phone: 310-886-0606
  • Fax: 310-886-0505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number55426
License Number StateCA

VIII. Authorized Official

Name: DR. VIHAR P BHAKTA
Title or Position: PRESIDENT
Credential: DMD
Phone: 310-988-6373