Provider Demographics
NPI:1780976290
Name:BIDVA, DAIVA (DDS)
Entity type:Individual
Prefix:DR
First Name:DAIVA
Middle Name:
Last Name:BIDVA
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 1:950 N YORK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-8657
Mailing Address - Country:US
Mailing Address - Phone:708-485-2828
Mailing Address - Fax:708-485-2829
Practice Address - Street 1:950 N YORK RD STE 110
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8657
Practice Address - Country:US
Practice Address - Phone:708-485-2828
Practice Address - Fax:708-485-2829
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190273141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice