Provider Demographics
NPI:1619499167
Name:BHATTAL, GAGANPREET KAUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GAGANPREET
Middle Name:KAUR
Last Name:BHATTAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W PETER LN
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-7512
Mailing Address - Country:US
Mailing Address - Phone:847-845-4406
Mailing Address - Fax:
Practice Address - Street 1:5225 TOUHY AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3245
Practice Address - Country:US
Practice Address - Phone:847-807-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001651-151223G0001X
IL019.0312621223G0001X
WA613845411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice