Healthcare Provider Details

I. General information

NPI: 1932723111
Provider Name (Legal Business Name): BHAVIK LAKHANI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5843 S WESTERN AVE
CHICAGO IL
60636-1526
US

IV. Provider business mailing address

8 W MONROE ST APT 1106
CHICAGO IL
60603-2450
US

V. Phone/Fax

Practice location:
  • Phone: 773-434-8600
  • Fax:
Mailing address:
  • Phone: 704-547-4841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019032652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: