Individual
DIVYA GADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1407 N VETERANS PKWY STE 12, BLOOMINGTON, IL 61704-6425
(309) 233-3922
Mailing address
1407 N VETERANS PKWY STE 12, BLOOMINGTON, IL 61704-6425
(309) 233-3922
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019033285
IL
Other
Enumeration date
06/29/2021
Last updated
07/10/2021
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