Provider Demographics
NPI:1215303136
Name:BHAGAT, KEYUR (DDS)
Entity type:Individual
Prefix:DR
First Name:KEYUR
Middle Name:
Last Name:BHAGAT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25507 GREEN TER
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2386
Mailing Address - Country:US
Mailing Address - Phone:210-577-0516
Mailing Address - Fax:
Practice Address - Street 1:27650 INTERSTATE 10 W STE 203
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2561
Practice Address - Country:US
Practice Address - Phone:210-577-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice