Healthcare Provider Details

I. General information

NPI: 1841615101
Provider Name (Legal Business Name): SAPAN M BHATT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ELM PLZ
WATERVILLE ME
04901-4936
US

IV. Provider business mailing address

160 ELM PLZ # ME04901
WATERVILLE ME
04901-4936
US

V. Phone/Fax

Practice location:
  • Phone: 866-568-2580
  • Fax:
Mailing address:
  • Phone: 978-828-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN4598
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: