MEDICARE: SHOWTIME DENTAL PLLC

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	29237	TX

General Provider Information

NPI Number	:	1952804064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOWTIME DENTAL PLLC

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	:
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	:	DENTIST
Name	:	DR. KEVIN R BHUVA
Credential	:	DDS
Telephone Number	:	917-331-1262

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	06/28/2023

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