Healthcare Provider Details

I. General information

NPI: 1851301238
Provider Name (Legal Business Name): VIJAY BHAGIA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 CLEAR LAKE CITY BLVD # C
HOUSTON TX
77062-8103
US

IV. Provider business mailing address

1140 CLEAR LAKE CITY BLVD # C
HOUSTON TX
77062-8103
US

V. Phone/Fax

Practice location:
  • Phone: 281-286-8945
  • Fax: 281-486-4193
Mailing address:
  • Phone: 281-286-8945
  • Fax: 281-486-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20597
License Number StateTX

VIII. Authorized Official

Name: DR. VIJAY BHAGIA
Title or Position: ORTHODONTIST
Credential: DMD, MS
Phone: 281-286-8945