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Individual

DR. BHAKTI DESAI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
801 S PAULINA ST, CHICAGO, IL 60612-7210
(312) 996-7555
Mailing address
801 SOUTH PAULINA, 269-H MC 850, CHICAGO, IL 60612
(205) 542-1717

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
019033434
IL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
019033434
ILLINOIS STATE DENTAL LICENSE
IL
Enumeration date
04/18/2020
Last updated
10/06/2022
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