Provider Demographics
NPI:1588128235
Name:BHARGAVA, ANURAG (DDS)
Entity type:Individual
Prefix:DR
First Name:ANURAG
Middle Name:
Last Name:BHARGAVA
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 1:1511 AMBLING TRL
Mailing Address - Street 2:CEDAR PARK
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:919-985-1895
Mailing Address - Fax:
Practice Address - Street 1:49 PERSHING DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1406
Practice Address - Country:US
Practice Address - Phone:203-732-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT124281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice