Provider Demographics
NPI:1093851875
Name:BOURI, ANIL K JR (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:K
Last Name:BOURI
Suffix:JR
Gender:M
Credentials:DDS, MSD
Other - Prefix:DR
Other - First Name:ANIL
Other - Middle Name:K
Other - Last Name:BOURI
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MSD
Mailing Address - Street 1:465 S SPRING RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5805
Mailing Address - Country:US
Mailing Address - Phone:630-530-4710
Mailing Address - Fax:630-530-4724
Practice Address - Street 1:465 S SPRING RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5805
Practice Address - Country:US
Practice Address - Phone:630-530-4710
Practice Address - Fax:630-530-4724
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics