Provider Demographics
NPI:1942355185
Name:S B NAIK DDS LTD
Entity Type:Organization
Organization Name:S B NAIK DDS LTD
Other - Org Name:S B NAIK DDS LTD
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:B
Authorized Official - Last Name:NAIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-452-2513
Mailing Address - Street 1:203 E SANTA FE, BOX 674
Mailing Address - Street 2:
Mailing Address - City:TOLUCA
Mailing Address - State:IL
Mailing Address - Zip Code:61369
Mailing Address - Country:US
Mailing Address - Phone:815-452-2513
Mailing Address - Fax:815-452-2585
Practice Address - Street 1:203 E SANTA FE, BOX 674
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190162121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003096Medicaid