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General NPI Number Information
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NPI Number | 1366629784
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Entity Type | Individual
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Provider Name | SUMITA BHARGAVA
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Gender | Female
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 1753 W ALGONQUIN RD
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City | MT PROSPECT
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State | IL
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Zip | 60056-5401
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Country | US
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Telephone | 847-952-1905
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 LOCKWOOD CT W
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1176
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Country | US
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Telephone | 847-478-0576
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.027541
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License Number State | IL
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