Healthcare Provider Details

I. General information

NPI: 1992625925
Provider Name (Legal Business Name): NAWAL DAIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 E GRAND AVE
LINDENHURST IL
60046-9041
US

IV. Provider business mailing address

671 OLD BARRINGTON RD
NORTH BARRINGTON IL
60010-7518
US

V. Phone/Fax

Practice location:
  • Phone: 847-265-9070
  • Fax:
Mailing address:
  • Phone: 847-609-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037345
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: