MEDICARE: FATEMA S VOHRA DDS LTD

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		IL

General Provider Information

NPI Number	:	1427129618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FATEMA S VOHRA DDS LTD

Provider Business Mailing Address
First Line	:	3622 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2216
Country	:	US
Telephone Number	:	773-486-5663
Fax Number	:	773-486-5663

Provider Business Practice Location Address
First Line	:	3622 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2216
Country	:	US
Telephone Number	:	773-486-5663
Fax Number	:	773-486-5663

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FATEMA S VOHRA
Credential	:	DDS
Telephone Number	:	773-486-5663

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	08/22/2020

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