Healthcare Provider Details

I. General information

NPI: 1689546509
Provider Name (Legal Business Name): AMREEN BHALLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N ROOT ST
AURORA IL
60505-3429
US

IV. Provider business mailing address

531 PARKSIDE DR
CAROL STREAM IL
60188-3976
US

V. Phone/Fax

Practice location:
  • Phone: 630-800-1137
  • Fax:
Mailing address:
  • Phone: 630-765-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019036524
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: