Healthcare Provider Details

I. General information

NPI: 1144560210
Provider Name (Legal Business Name): CHAWLA ORTHODONTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 N CASS AVE STE 401
WESTMONT IL
60559-1514
US

IV. Provider business mailing address

519 N CASS AVE STE 401
WESTMONT IL
60559-1514
US

V. Phone/Fax

Practice location:
  • Phone: 630-914-6060
  • Fax: 630-442-7216
Mailing address:
  • Phone: 630-914-6060
  • Fax: 630-442-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number019020214
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number019027777
License Number StateIL

VIII. Authorized Official

Name: DR. SUMIT CHAWLA
Title or Position: ORTHODONTIST/OWNER
Credential: D.M.D.
Phone: 630-914-6060