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General NPI Number Information
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NPI Number | 1891176988
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Entity Type | Individual
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Provider Name | GUNVEEN CHAWLA
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Gender | Female
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 366 W ARMY TRAIL RD STE 310A
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City | BLOOMINGDALE
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State | IL
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Zip | 60108
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Country | US
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Telephone | 978-466-6800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860036
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0036
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Country | US
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Telephone | 917-702-9234
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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 | DN1856963
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.031571
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License Number State | IL
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