Basic Information
| Provider Information | |||||||||
| NPI: | 1386843985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHATIA | ||||||||
| FirstName: | PRIYADARSHINI | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 HAVEN AVE | ||||||||
| Address2: | #5203 | ||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917306958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004174444 | ||||||||
| FaxNumber: | 7145713560 | ||||||||
| Practice Location | |||||||||
| Address1: | 15290 BEAR VALLEY RD | ||||||||
| Address2: | STE. B | ||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923958515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609517777 | ||||||||
| FaxNumber: | 7609511582 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 55789 | CA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | D55789 | 05 | CA | MEDICAID |