Healthcare Provider Details

I. General information

NPI: 1396023743
Provider Name (Legal Business Name): ANITA BHATT DMD,MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 TURNPIKE RD
WESTBOROUGH MA
01581-2810
US

IV. Provider business mailing address

210 TURNPIKE RD
WESTBOROUGH MA
01581-2810
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-4800
  • Fax: 508-366-7680
Mailing address:
  • Phone: 508-366-4800
  • Fax: 508-366-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19977
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: