Provider Demographics
NPI:1902294291
Name:SUDHIR K. BHATIA DDS MS LTD
Entity type:Organization
Organization Name:SUDHIR K. BHATIA DDS MS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-725-0947
Mailing Address - Street 1:7451 WOODWARD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2665
Mailing Address - Country:US
Mailing Address - Phone:630-725-0947
Mailing Address - Fax:630-725-0949
Practice Address - Street 1:7451 WOODWARD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2665
Practice Address - Country:US
Practice Address - Phone:630-725-0947
Practice Address - Fax:630-725-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190151831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1245316546Medicaid