MEDICARE: DR. SUNDEEP DHAWAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019028275	IL

General Provider Information

NPI Number	:	1962721696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNDEEP DHAWAN D.D.S.

Provider Business Mailing Address
First Line	:	7714 SOUTH CICERO AVENUE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1583
Country	:	US
Telephone Number	:	708-636-3368
Fax Number	:	708-636-7109

Provider Business Practice Location Address
First Line	:	7714 SOUTH CICERO AVENUE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1583
Country	:	US
Telephone Number	:	708-636-3368
Fax Number	:	708-636-7109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	12/20/2011

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