Healthcare Provider Details

I. General information

NPI: 1528871233
Provider Name (Legal Business Name): BHAKTI VACHHANI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 ROLLING RIDGE DR STE 1
STATE COLLEGE PA
16801-7640
US

IV. Provider business mailing address

650 TOFTREES AVE APT 301
STATE COLLEGE PA
16803-1978
US

V. Phone/Fax

Practice location:
  • Phone: 814-237-1777
  • Fax:
Mailing address:
  • Phone: 248-881-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS044961
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: