Provider Demographics
NPI:1538552393
Name:BHANSALI, HETA (DDS)
Entity type:Individual
Prefix:
First Name:HETA
Middle Name:
Last Name:BHANSALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 J ST
Mailing Address - Street 2:UNIT 7161
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6966
Mailing Address - Country:US
Mailing Address - Phone:216-835-7998
Mailing Address - Fax:
Practice Address - Street 1:29910 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:SUITE R
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3814
Practice Address - Country:US
Practice Address - Phone:951-677-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist