Healthcare Provider Details

I. General information

NPI: 1003992561
Provider Name (Legal Business Name): JAVED BHOJANI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 ORCHARD RD
OSWEGO IL
60543-5013
US

IV. Provider business mailing address

1301 ORCHARD RD
OSWEGO IL
60543-5013
US

V. Phone/Fax

Practice location:
  • Phone: 630-882-2996
  • Fax: 630-206-2498
Mailing address:
  • Phone: 630-882-2996
  • Fax: 630-516-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-025465
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: