Healthcare Provider Details

I. General information

NPI: 1104885854
Provider Name (Legal Business Name): BHARATI JASMEET BEDI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 12/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 GREENBELT PKWY
HOLTSVILLE NY
11742-2207
US

IV. Provider business mailing address

280 GREENBELT PKWY
HOLTSVILLE NY
11742-2207
US

V. Phone/Fax

Practice location:
  • Phone: 631-472-1832
  • Fax: 631-472-9725
Mailing address:
  • Phone: 631-472-1832
  • Fax: 631-472-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number051346
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: