Provider Demographics
NPI:1073750287
Name:HATIA, UZMA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:UZMA
Middle Name:S
Last Name:HATIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N HERSHEY RD STE D
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3744
Mailing Address - Country:US
Mailing Address - Phone:309-661-0197
Mailing Address - Fax:309-663-0967
Practice Address - Street 1:507 N HERSHEY RD STE D
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3744
Practice Address - Country:US
Practice Address - Phone:309-661-0197
Practice Address - Fax:309-663-0967
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist