Provider Demographics
NPI:1043983844
Name:BHALALA, AKSHAYKUMAR KAMLESHBHAI (DDS)
Entity type:Individual
Prefix:DR
First Name:AKSHAYKUMAR
Middle Name:KAMLESHBHAI
Last Name:BHALALA
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 1:775 S PARK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3813
Mailing Address - Country:US
Mailing Address - Phone:678-839-0031
Mailing Address - Fax:
Practice Address - Street 1:775 S PARK ST STE 101
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3813
Practice Address - Country:US
Practice Address - Phone:678-839-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1224421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice