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NPI Code Detail

MEDICARE: BHAVANA THAKUR D.D.S

MEDICARE: BHAVANA THAKUR D.D.S
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
1261QD0000XDental Clinic/CenterCA 45033CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G9324101OTHERCADENTICAL ,CA

General Provider Information

NPI Number : 1619019643
Entity Type Code : Organization
Provider Name (Legal Business Name) : BHAVANA THAKUR D.D.S
Provider Business Mailing Address
First Line : 281 E . HAMILTON AVE
Second Line : SUITE#3
City : CAMPBELL
State : CA
Zip : 95008
Country : US
Telephone Number : 408-871-0877
Fax Number : 408-871-2807
Provider Business Practice Location Address
First Line : 281 E HAMILTON AVE
Second Line : SUITE#3
City : CAMPBELL
State : CA
Zip : 95008-0232
Country : US
Telephone Number : 408-871-0877
Fax Number : 408-871-2807
Authorized Official
Title or Position : OWNER DENTIST
Name : BHAVANA N THAKUR
Credential : D.D.S.
Telephone Number : 408-871-0877
Provider Enumeration Date : 02/13/2007
Last Update Date : 08/22/2020

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