Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 56738 | CA |
NPI | 1003091232 |
---|---|
Provider Name | Bhavini Harish Shelat |
First Address | Modesto, CA 95356-1884 |
Second Address | Modesto, CA 95355-1756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2008 |
Last Update Date | 10/11/2016 |