MEDICARE: KEVIN R BHUVA

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	29237	TX

General Provider Information

NPI Number	:	1902247679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN R BHUVA

Provider Business Mailing Address
First Line	:	3401 ALTAMESA BLVD STE 128
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5773
Country	:	US
Telephone Number	:	817-361-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 ALTAMESA BLVD STE 128
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5773
Country	:	US
Telephone Number	:	817-361-8111
Fax Number	:

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

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	07/09/2023

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