Provider Demographics
NPI:1124757711
Name:BEDI, BRIANNA J (DMD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:J
Last Name:BEDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-5811
Mailing Address - Country:US
Mailing Address - Phone:630-709-2365
Mailing Address - Fax:
Practice Address - Street 1:1121 WARREN AVE STE 130
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3594
Practice Address - Country:US
Practice Address - Phone:630-663-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190336061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice