Individual
KETAN S BEDMUTHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1950 W CERMAK RD, CHICAGO, IL 60608-4204
(773) 376-2777
Mailing address
601 W JACKSON BLVD UNIT 1404, CHICAGO, IL 60661-5642
(716) 725-1593
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.032066
IL
Other
Enumeration date
03/27/2018
Last updated
04/24/2021
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