Basic Information
| Provider Information | |||||||||
| NPI: | 1265962310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHATT | ||||||||
| FirstName: | NEAL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 E ALGONQUIN RD STE 610 | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889884066 | ||||||||
| FaxNumber: | 8474964850 | ||||||||
| Practice Location | |||||||||
| Address1: | 551 N. STEMMONS ST. | ||||||||
| Address2: | SUITE | ||||||||
| City: | SANGER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762667626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404589000 | ||||||||
| FaxNumber: | 9404589001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2017 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 33055 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.