Provider Demographics
NPI:1598432791
Name:BAWA, DEVAANSH (DDS, MSD)
Entity type:Individual
Prefix:
First Name:DEVAANSH
Middle Name:
Last Name:BAWA
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 LOU ALICE WAY
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4206
Mailing Address - Country:US
Mailing Address - Phone:571-218-0083
Mailing Address - Fax:
Practice Address - Street 1:6800 MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516
Practice Address - Country:US
Practice Address - Phone:630-969-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014186961223X0400X
MD181251223X0400X
IL019.0361651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics