Provider Demographics
NPI:1558533463
Name:VIBHAKAR, CHARU K (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARU
Middle Name:K
Last Name:VIBHAKAR
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 1:3902 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-1208
Mailing Address - Country:US
Mailing Address - Phone:708-442-1900
Mailing Address - Fax:708-442-4999
Practice Address - Street 1:3902 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1208
Practice Address - Country:US
Practice Address - Phone:708-442-1900
Practice Address - Fax:708-442-4999
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist