Provider Demographics
NPI:1326219379
Name:NAIK, S B (DDS)
Entity Type:Individual
Prefix:DR
First Name:S
Middle Name:B
Last Name:NAIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:S
Other - Middle Name:B
Other - Last Name:NAIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:TOLUCA
Mailing Address - State:IL
Mailing Address - Zip Code:61369-0674
Mailing Address - Country:US
Mailing Address - Phone:815-452-2513
Mailing Address - Fax:815-452-2585
Practice Address - Street 1:203 E SANTA FE
Practice Address - Street 2:
Practice Address - City:TOLUCA
Practice Address - State:IL
Practice Address - Zip Code:61369
Practice Address - Country:US
Practice Address - Phone:815-452-2513
Practice Address - Fax:815-452-2585
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190162121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003096Medicaid