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General NPI Number Information
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NPI Number | 1689593923
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Entity Type | Organization
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Legal Business Name | GUR NANAK PLLC
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Dates
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Enumeration Date | 07/11/2026
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Last Update Date | 07/11/2026
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Provider Practice Location Address
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Address Line | 5912 W CERMAK RD
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City | CICERO
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State | IL
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Zip | 60804-2135
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Country | US
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Telephone | 708-298-9167
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Fax |
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Provider Business Mailing Address
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Address Line | 5455 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60639-4346
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Country | US
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Telephone | 631-220-7839
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMITOJ SINGH MEHTA
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Credential | DDS
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Telephone | 631-220-7839
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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