Provider Demographics
NPI:1053538199
Name:BHATT, DEEPA S (DDS)
Entity type:Individual
Prefix:MISS
First Name:DEEPA
Middle Name:S
Last Name:BHATT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W. ARMITAGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3718
Mailing Address - Country:US
Mailing Address - Phone:773-276-9280
Mailing Address - Fax:773-276-9281
Practice Address - Street 1:3300 W. ARMITAGE AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3718
Practice Address - Country:US
Practice Address - Phone:773-276-9280
Practice Address - Fax:773-276-9281
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190272041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice