Healthcare Provider Details

I. General information

NPI: 1801523261
Provider Name (Legal Business Name): SOMARA BUKHARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 ALPINE SPRINGS DR
VERNON HILLS IL
60061-2345
US

IV. Provider business mailing address

317 ALPINE SPRINGS DR
VERNON HILLS IL
60061-2345
US

V. Phone/Fax

Practice location:
  • Phone: 312-730-4477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019033903
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: