Provider Demographics
NPI:1053609685
Name:DHADWAL, SUSHANT (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSHANT
Middle Name:
Last Name:DHADWAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5982 DANBY CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5212
Mailing Address - Country:US
Mailing Address - Phone:201-780-5103
Mailing Address - Fax:
Practice Address - Street 1:2537 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1121
Practice Address - Country:US
Practice Address - Phone:708-345-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190290731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice