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NPI Code Detail

MEDICARE: NAZNIN BHOLAT DDS, A DENTAL CORPORATION

MEDICARE: NAZNIN BHOLAT DDS, A DENTAL CORPORATION
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
11223G0001XGeneral Practice Dentistry61123CA

General Provider Information

NPI Number : 1891114609
Entity Type Code : Organization
Provider Name (Legal Business Name) : NAZNIN BHOLAT DDS, A DENTAL CORPORATION
Provider Business Mailing Address
First Line : 31581 CANYON ESTATES DR STE 201
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0424
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 31581 CANYON ESTATES DR STE 201
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0424
Country : US
Telephone Number : 805-405-1730
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. NAZNIN BHOLAT
Credential : DDS
Telephone Number : 805-405-1730
Provider Enumeration Date : 04/09/2014
Last Update Date : 04/09/2014

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