Basic Information
Provider Information
NPI: 1215303136
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHAGAT
FirstName: KEYUR
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8100 PINEBROOK DR
Address2: APT 2103
City: SAN ANTONIO
State: TX
PostalCode: 782304734
CountryCode: US
TelephoneNumber: 2105770516
FaxNumber:  
Practice Location
Address1: 5999 DE ZAVALA RD
Address2: STE. 122
City: SAN ANTONIO
State: TX
PostalCode: 782492233
CountryCode: US
TelephoneNumber: 2106911333
FaxNumber: 2105612599
Other Information
ProviderEnumerationDate: 08/14/2015
LastUpdateDate: 08/14/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X31040TXY Dental ProvidersDentistGeneral Practice

No ID Information.


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