Provider Demographics
NPI:1083878151
Name:BHUSHAN, NEETA F (DDS)
Entity Type:Individual
Prefix:
First Name:NEETA
Middle Name:F
Last Name:BHUSHAN
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 1:5855 N SHERIDAN RD
Mailing Address - Street 2:UNIT 26A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3818
Mailing Address - Country:US
Mailing Address - Phone:773-562-7868
Mailing Address - Fax:630-739-5500
Practice Address - Street 1:136 S BOLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2852
Practice Address - Country:US
Practice Address - Phone:630-739-5500
Practice Address - Fax:630-739-5505
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019027625OtherLICENSE NUMBER