Provider Demographics
NPI:1003062464
Name:BHANSALI, CHEITALI (DMD)
Entity Type:Individual
Prefix:
First Name:CHEITALI
Middle Name:
Last Name:BHANSALI
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 1:1883 CHIPPENDALE LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1916
Mailing Address - Country:US
Mailing Address - Phone:630-452-2406
Mailing Address - Fax:
Practice Address - Street 1:8715 RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1001
Practice Address - Country:US
Practice Address - Phone:708-599-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0277961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice