Provider Demographics
NPI:1750678629
Name:SHUBA BINDRA DDS PC
Entity Type:Organization
Organization Name:SHUBA BINDRA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUBA
Authorized Official - Middle Name:SADAGOPAN
Authorized Official - Last Name:BINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-672-2235
Mailing Address - Street 1:1250 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2548
Mailing Address - Country:US
Mailing Address - Phone:312-672-2235
Mailing Address - Fax:
Practice Address - Street 1:1250 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2548
Practice Address - Country:US
Practice Address - Phone:312-672-2235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9028039Medicaid