Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019029628 | IL |
NPI | 1003242520 |
---|---|
Provider Name | Dr. Bindi K Vibhakar |
First Address | Lyons, IL 60534-1208 |
Second Address | Lyons, IL 60534-1208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 16/09/2013 |