Provider Demographics
NPI:1962850537
Name:DAHIYA, GINU DEVI (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:GINU
Middle Name:DEVI
Last Name:DAHIYA
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 N DEARBORN ST
Mailing Address - Street 2:APT 707
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7835
Mailing Address - Country:US
Mailing Address - Phone:216-269-9121
Mailing Address - Fax:
Practice Address - Street 1:5333 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2121
Practice Address - Country:US
Practice Address - Phone:773-728-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030612122300000X
IL0210027471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist