MEDICARE: DR. KALIN JEETESH BHAVAN DDS

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	1223G0001X	General Practice Dentistry	38789	TX

General Provider Information

NPI Number	:	1639805781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALIN JEETESH BHAVAN DDS

Provider Business Mailing Address
First Line	:	2529 CIMA HILL DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-4765
Country	:	US
Telephone Number	:	214-562-7068
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 E ELLIOTT ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-3708
Country	:	US
Telephone Number	:	940-696-9702
Fax Number	:	940-691-8425

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

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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