Provider Demographics
NPI:1528181575
Name:SAMA, SREELEKHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SREELEKHA
Middle Name:
Last Name:SAMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N SWIFT RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1476
Mailing Address - Country:US
Mailing Address - Phone:630-627-7626
Mailing Address - Fax:
Practice Address - Street 1:190 N SWIFT RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1476
Practice Address - Country:US
Practice Address - Phone:630-627-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190265201223G0001X
IL019.0265201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics