MEDICARE: SUMITA BHARGAVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.027541	IL

General Provider Information

NPI Number	:	1366629784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMITA BHARGAVA

Provider Business Mailing Address
First Line	:	1146 LOCKWOOD CT W
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1176
Country	:	US
Telephone Number	:	847-478-0576
Fax Number	:

Provider Business Practice Location Address
First Line	:	1753 W ALGONQUIN RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-5401
Country	:	US
Telephone Number	:	847-952-1905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/17/2012

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Directions to “ SUMITA BHARGAVA ” Practice Location

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