Healthcare Provider Details

I. General information

NPI: 1003563529
Provider Name (Legal Business Name): RICHA BHATIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 W 95TH ST FL 2
OAK LAWN IL
60453-2255
US

IV. Provider business mailing address

6305 W 95TH ST FL 2
OAK LAWN IL
60453-2255
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-1300
  • Fax: 708-424-1786
Mailing address:
  • Phone: 708-424-1300
  • Fax: 708-424-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601228
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number019034704
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: