Healthcare Provider Details

I. General information

NPI: 1265356059
Provider Name (Legal Business Name): KRUTI BHAKTA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 N 38TH ST
BROKEN ARROW OK
74014-1312
US

IV. Provider business mailing address

2151 W WRANGLER BLVD
SEMINOLE OK
74868-2045
US

V. Phone/Fax

Practice location:
  • Phone: 918-994-0028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8188
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: