Healthcare Provider Details

I. General information

NPI: 1437823259
Provider Name (Legal Business Name): BHAVIN H GAJJAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 02/23/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 NW 57TH STREET
GAINSVILLE FL
32605
US

IV. Provider business mailing address

908 NW 57TH STREET
GAINSVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-8199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37623
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD11546
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN28802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: