Healthcare Provider Details

I. General information

NPI: 1811127582
Provider Name (Legal Business Name): PRIYADARSHINI BOINPALLY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 GREENBAY RD
HIGHWOOD IL
60040-2410
US

IV. Provider business mailing address

410 GREENBAY
HIGHWOOD IL
60040
US

V. Phone/Fax

Practice location:
  • Phone: 847-230-9394
  • Fax: 847-847-2792
Mailing address:
  • Phone: 847-230-9394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.028057
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019028057
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: