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General NPI Number Information
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NPI Number | 1306423314
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Entity Type | Individual
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Provider Name | ROHAN BANSAL
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Gender | Male
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | 8704 RIDGELAND AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-1068
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Country | US
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Telephone | 708-430-4440
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Fax |
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Provider Business Mailing Address
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Address Line | 8704 RIDGELAND AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-1068
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Country | US
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Telephone | 708-430-4440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 018002174
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019033432
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License Number State | IL
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