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General NPI Number Information
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NPI Number | 1255169520
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Entity Type | Individual
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Provider Name | DR. SUSHEEL KUMAR NALLI
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Gender | Male
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Dates
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Enumeration Date | 07/26/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 2459 W JONATHAN MOORE PIKE
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City | COLUMBUS
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State | IN
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Zip | 47201-9206
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Country | US
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Telephone | 812-516-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 W CHICAGO AVE
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3316
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Country | US
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Telephone | 888-580-1060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12014429A
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License Number State | IN
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