MEDICARE: JASPREET DHINGRA-BAJAJ, 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	1223G0001X	General Practice Dentistry	19027728	IL

General Provider Information

NPI Number	:	1447594767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASPREET DHINGRA-BAJAJ, LTD

Provider Business Mailing Address
First Line	:	100 E ROOSEVELT RD STE 14
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-3529
Country	:	US
Telephone Number	:	630-501-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E ROOSEVELT RD STE 14
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-3529
Country	:	US
Telephone Number	:	630-501-0404
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. JASPREET DHRINGRA-BAJAJ
Credential	:	DDS
Telephone Number	:	630-501-0404

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	11/27/2012

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