Individual
BHARGAVI DASARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1407 N VETERANS PKWY STE 12, BLOOMINGTON, IL 61704-6425
(862) 452-0916
Mailing address
1726 EIDE RD, BLOOMINGTON, IL 61704-8734
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19033698
IL
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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