Provider Demographics
NPI:1164950010
Name:GANGER, URVI SHUKLA (DDS)
Entity Type:Individual
Prefix:
First Name:URVI
Middle Name:SHUKLA
Last Name:GANGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:URVI
Other - Middle Name:VINAY
Other - Last Name:SHUKLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1858 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1201
Mailing Address - Country:US
Mailing Address - Phone:773-247-5554
Mailing Address - Fax:773-247-8272
Practice Address - Street 1:1858 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1201
Practice Address - Country:US
Practice Address - Phone:773-247-5554
Practice Address - Fax:773-247-8272
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190314641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019031464OtherLICENSE NUMBER