Provider Demographics
NPI:1366629784
Name:BHARGAVA, SUMITA
Entity Type:Individual
Prefix:
First Name:SUMITA
Middle Name:
Last Name:BHARGAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 LOCKWOOD CT W
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1176
Mailing Address - Country:US
Mailing Address - Phone:847-478-0576
Mailing Address - Fax:
Practice Address - Street 1:1753 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-5401
Practice Address - Country:US
Practice Address - Phone:847-952-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist