Provider Demographics
NPI:1457056343
Name:AMOGH BHALERAO DDS PLLC
Entity type:Organization
Organization Name:AMOGH BHALERAO DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMOGH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALERAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-585-1064
Mailing Address - Street 1:5460 BABCOCK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3400
Mailing Address - Country:US
Mailing Address - Phone:813-585-1064
Mailing Address - Fax:
Practice Address - Street 1:5460 BABCOCK RD STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3400
Practice Address - Country:US
Practice Address - Phone:813-585-1064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty