Provider Demographics
NPI:1295065548
Name:DR. SIBTAIN KERAI, P.C.
Entity type:Organization
Organization Name:DR. SIBTAIN KERAI, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:815-556-8126
Mailing Address - Street 1:1322 WESTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5852
Mailing Address - Country:US
Mailing Address - Phone:815-556-8126
Mailing Address - Fax:
Practice Address - Street 1:335 N SCHMIDT RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1702
Practice Address - Country:US
Practice Address - Phone:630-759-1200
Practice Address - Fax:630-759-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16907122300000X
IL019-026667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty