Provider Demographics
NPI:1962841601
Name:HULIYAR, VIKASH SURESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIKASH
Middle Name:SURESH
Last Name:HULIYAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N LARRABEE ST APT 912
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5060
Mailing Address - Country:US
Mailing Address - Phone:630-908-0120
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE STE 1517
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-291-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190294401223G0001X
AZ92791223G0001X
IL0210029781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice