Provider Demographics
NPI:1003563529
Name:BHATIA, RICHA (DDS)
Entity type:Individual
Prefix:
First Name:RICHA
Middle Name:
Last Name:BHATIA
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 1:6305 W 95TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2255
Mailing Address - Country:US
Mailing Address - Phone:708-424-1300
Mailing Address - Fax:708-424-1786
Practice Address - Street 1:6305 W 95TH ST FL 2
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2255
Practice Address - Country:US
Practice Address - Phone:708-424-1300
Practice Address - Fax:708-424-1786
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190347041223P0221X
MI2901601228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist