Provider Demographics
NPI:1245709047
Name:KOIRALA, SARASWATI (DMD)
Entity type:Individual
Prefix:DR
First Name:SARASWATI
Middle Name:
Last Name:KOIRALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 S HARLEM AVE APT 414
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1049
Mailing Address - Country:US
Mailing Address - Phone:571-296-4809
Mailing Address - Fax:
Practice Address - Street 1:1227 S HARLEM AVE APT414
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:571-296-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist