Healthcare Provider Details

I. General information

NPI: 1710363734
Provider Name (Legal Business Name): SK DENTAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 ROUTE 47 SUITE J
SUGAR GROVE IL
60554
US

IV. Provider business mailing address

495 ROUTE 47 SUITE J
SUGAR GROVE IL
60554
US

V. Phone/Fax

Practice location:
  • Phone: 630-466-1100
  • Fax: 630-466-7933
Mailing address:
  • Phone: 630-466-1100
  • Fax: 630-466-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. SIBTAIN KERAI
Title or Position: PRESIDENT/ OWNER
Credential: DDS
Phone: 630-466-1100