Priyadarshini S Bhatia
Individual provider Active NPI Dentist · Victorville, CA
NPI 1386843985 · NPPES record last updated Jul 13, 2007
Key facts
- NPI
- 1386843985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 55789 (CA)
- Practice address
- 15290 Bear Valley Rd
Ste. B
Victorville, CA 92395-8515 - Phone
- (760) 951-7777
- Fax
- (760) 951-1582
- NPI assigned
- Jul 13, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150814014916 | CA | Order and Referring Only - Dentist |
3779898069 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Dental Services, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 55789 | CA | Yes |
Addresses
Primary practice location
15290 Bear Valley Rd
Ste. B
Victorville, CA 92395-8515
Mailing address
8200 Haven Ave
#5203
Rancho Cucamonga, CA 91730-6958
Phone (800) 417-4444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D55789 | Medicaid | CA |
Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.