Provider Demographics
NPI:1407739642
Name:KODALI, SILESHINI (BDS)
Entity type:Individual
Prefix:
First Name:SILESHINI
Middle Name:
Last Name:KODALI
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 BEAUMONT DR APT 105
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1820
Mailing Address - Country:US
Mailing Address - Phone:571-442-3126
Mailing Address - Fax:
Practice Address - Street 1:4501 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3758
Practice Address - Country:US
Practice Address - Phone:872-203-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019036346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist