Provider Demographics
NPI:1891472064
Name:BHURGRI, ROHAIL ISAAC (DMD)
Entity Type:Individual
Prefix:
First Name:ROHAIL
Middle Name:ISAAC
Last Name:BHURGRI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1083
Mailing Address - Country:US
Mailing Address - Phone:815-830-7580
Mailing Address - Fax:
Practice Address - Street 1:515 US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-8814
Practice Address - Country:US
Practice Address - Phone:815-620-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist