MEDICARE: DR. DEEPALI MEHTA BHANOT D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	11954	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225031214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPALI MEHTA BHANOT D.M.D.

Provider Business Mailing Address
First Line	:	20400 OBSERVATION DR
Second Line	:	# 208
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-4085
Country	:	US
Telephone Number	:	301-528-8685
Fax Number	:	301-528-2051

Provider Business Practice Location Address
First Line	:	20400 OBSERVATION DR
Second Line	:	# 208
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-4085
Country	:	US
Telephone Number	:	301-528-8685
Fax Number	:	301-528-2051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/11/2023

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