Healthcare Provider Details

I. General information

NPI: 1164622825
Provider Name (Legal Business Name): SHIKHA BUBNA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 S HARLEM AVE
PALOS HEIGHTS IL
60463-1139
US

IV. Provider business mailing address

12001 S HARLEM AVE
PALOS HEIGHTS IL
60463-1139
US

V. Phone/Fax

Practice location:
  • Phone: 708-448-6700
  • Fax: 708-448-7939
Mailing address:
  • Phone: 708-448-6700
  • Fax: 708-448-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19027469
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: