Healthcare Provider Details

I. General information

NPI: 1073126199
Provider Name (Legal Business Name): DR. ESHA BHATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E MAPLE ST
GILLESPIE IL
62033-1473
US

IV. Provider business mailing address

205 OAKLAND AVE
CARLINVILLE IL
62626-1921
US

V. Phone/Fax

Practice location:
  • Phone: 217-854-3223
  • Fax:
Mailing address:
  • Phone: 217-854-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number12916
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019034014
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: