Individual
ASHU BANSAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
933 W VAN BUREN ST, 623, CHICAGO, IL 60607-3588
(414) 737-1037
Mailing address
933 W VAN BUREN ST, 623, CHICAGO, IL 60607-3588
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019029830
IL
Other
Enumeration date
09/22/2014
Last updated
09/22/2014
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