Provider Demographics
NPI:1114241650
Name:PRIYATIRUMALASETTY, DDS PC
Entity Type:Organization
Organization Name:PRIYATIRUMALASETTY, DDS PC
Other - Org Name:PRIYA SETTY, DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRUMALASETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-880-1400
Mailing Address - Street 1:223 W JACKSON BLVD STE 1106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-6900
Mailing Address - Country:US
Mailing Address - Phone:312-880-1400
Mailing Address - Fax:312-880-1401
Practice Address - Street 1:223 W JACKSON BLVD STE 1106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-6900
Practice Address - Country:US
Practice Address - Phone:312-880-1400
Practice Address - Fax:312-880-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026732122300000X
IL019-0248631223G0001X
IL020012084124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty