Provider Demographics
NPI:1215927884
Name:BHAGAT, DEEPAK K (DDS)
Entity type:Individual
Prefix:MR
First Name:DEEPAK
Middle Name:K
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 1:3094 51ST ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1457
Mailing Address - Country:US
Mailing Address - Phone:718-956-8400
Mailing Address - Fax:718-267-8551
Practice Address - Street 1:3094 51ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1457
Practice Address - Country:US
Practice Address - Phone:718-956-8400
Practice Address - Fax:718-267-8551
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0411601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01062431Medicaid