Provider Demographics
NPI:1730650086
Name:CERMAK DENTISTRY LLC
Entity Type:Organization
Organization Name:CERMAK DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER DENTIST
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:773-376-2777
Mailing Address - Street 1:1950 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4204
Mailing Address - Country:US
Mailing Address - Phone:773-376-2777
Mailing Address - Fax:
Practice Address - Street 1:1950 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4204
Practice Address - Country:US
Practice Address - Phone:773-376-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty