MEDICARE: ABHINAV BHATNAGAR

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	122300000X	Dentist	30.026245	OH
2	122300000X	Dentist	DN1858495	MA

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	:	1417506106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABHINAV BHATNAGAR

Provider Business Mailing Address
First Line	:	600 W 3RD ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-2633
Country	:	US
Telephone Number	:	419-522-2619
Fax Number	:	419-525-6723

Provider Business Practice Location Address
First Line	:	31 E MAIN ST
Second Line	:
City	:	SHELBY
State	:	OH
Zip	:	44875-1262
Country	:	US
Telephone Number	:	419-525-6797
Fax Number	:	419-525-6723

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

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	10/12/2020

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