Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 9731 | TN |
NPI | 1376807651 |
---|---|
Provider Name | Vaishali Bhakta |
First Address | Murfreesboro, TN 37130-3657 |
Second Address | Murfreesboro, TN 37130-3657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2012 |
Last Update Date | 08/08/2013 |