Provider Demographics
NPI:1669612065
Name:CHAWLA, SUMIT (DMD)
Entity type:Individual
Prefix:DR
First Name:SUMIT
Middle Name:
Last Name:CHAWLA
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 1:519 N CASS AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1514
Mailing Address - Country:US
Mailing Address - Phone:630-772-0786
Mailing Address - Fax:
Practice Address - Street 1:519 N CASS AVE STE 401
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1514
Practice Address - Country:US
Practice Address - Phone:630-914-6060
Practice Address - Fax:630-442-7216
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5791122300000X
IL019027777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist