Healthcare Provider Details

I. General information

NPI: 1629620323
Provider Name (Legal Business Name): BAPNA FACIAL PLASTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5378 AVERY RD
DUBLIN OH
43016-6933
US

IV. Provider business mailing address

5378 AVERY RD
DUBLIN OH
43016-6933
US

V. Phone/Fax

Practice location:
  • Phone: 614-876-6673
  • Fax: 614-876-8674
Mailing address:
  • Phone: 614-876-6673
  • Fax: 614-876-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SUMIT BAPNA
Title or Position: CEO
Credential:
Phone: 614-876-6673