Provider Demographics
NPI:1245316546
Name:BHATIA, SUDHIR KUMAR (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:KUMAR
Last Name:BHATIA
Suffix:
Gender:M
Credentials:DDS,MS
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Other - First Name:
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Mailing Address - Street 1:7451 WOODWARD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2665
Mailing Address - Country:US
Mailing Address - Phone:630-725-0947
Mailing Address - Fax:630-725-0949
Practice Address - Street 1:7451 WOODWARD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2665
Practice Address - Country:US
Practice Address - Phone:630-725-0947
Practice Address - Fax:630-725-0949
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry