MEDICARE: DR. PAYAL BHAN 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
1	1223G0001X	General Practice Dentistry	23055	TX

General Provider Information

NPI Number	:	1669670881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAYAL BHAN D.D.S.

Provider Business Mailing Address
First Line	:	2009 LAZY LAKE DR
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-7858
Country	:	US
Telephone Number	:	912-281-1849
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 LAZY LAKE DR
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-7858
Country	:	US
Telephone Number	:	912-281-1849
Fax Number	:

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	04/18/2009

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