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General NPI Number Information
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NPI Number | 1336346089
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Entity Type | Individual
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Provider Name | VIJEYTA BHATIA DDS
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Gender | Female
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 109 N WILLIAMSBURG DR
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City | BLOOMINGTON
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State | IL
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Zip | 61704-3528
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Country | US
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Telephone | 309-662-3123
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Fax | 309-661-0798
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Provider Business Mailing Address
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Address Line | 109 N WILLIAMSBURG DR
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City | BLOOMINGTON
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State | IL
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Zip | 61704-3528
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Country | US
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Telephone | 309-662-3123
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Fax | 309-661-0798
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019026166
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8960
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License Number State | MA
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