Provider Demographics
NPI:1710363734
Name:SK DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:SK DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIBTAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-466-1100
Mailing Address - Street 1:495 ROUTE 47
Mailing Address - Street 2:SUITE J
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554
Mailing Address - Country:US
Mailing Address - Phone:630-466-1100
Mailing Address - Fax:630-466-7933
Practice Address - Street 1:495 ROUTE 47
Practice Address - Street 2:SUITE J
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554
Practice Address - Country:US
Practice Address - Phone:630-466-1100
Practice Address - Fax:630-466-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty