Healthcare Provider Details

I. General information

NPI: 1689593923
Provider Name (Legal Business Name): GUR NANAK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 W CERMAK RD
CICERO IL
60804-2135
US

IV. Provider business mailing address

5455 W NORTH AVE
CHICAGO IL
60639-4346
US

V. Phone/Fax

Practice location:
  • Phone: 708-298-9167
  • Fax:
Mailing address:
  • Phone: 631-220-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AMITOJ SINGH MEHTA
Title or Position: PRESIDENT
Credential: DDS
Phone: 631-220-7839