Provider Demographics
NPI:1558310565
Name:NIRO-KRAEMER, JACQUELINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:NIRO-KRAEMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AFSANEH
Other - Middle Name:
Other - Last Name:NIROUMANDPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:125 MILLIS LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1039
Mailing Address - Country:US
Mailing Address - Phone:847-275-8336
Mailing Address - Fax:847-490-9920
Practice Address - Street 1:2200 W HIGGINS RD STE 335
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2484
Practice Address - Country:US
Practice Address - Phone:847-490-8708
Practice Address - Fax:847-490-9920
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-23708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003137Medicaid