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General NPI Number Information
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NPI Number | 1295065548
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Entity Type | Organization
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Legal Business Name | DR. SIBTAIN KERAI, P.C.
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Dates
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Enumeration Date | 01/09/2010
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Last Update Date | 01/09/2010
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Provider Practice Location Address
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Address Line | 335 N SCHMIDT RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1702
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Country | US
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Telephone | 630-759-1200
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Fax | 630-759-3505
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Provider Business Mailing Address
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Address Line | 1322 WESTHAMPTON DR
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City | PLAINFIELD
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State | IL
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Zip | 60586-5852
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Country | US
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Telephone | 815-556-8126
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIBTAIN KERAI
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Credential | D.D.S.
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Telephone | 815-556-8126
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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 | DN 16907
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-026667
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License Number State | IL
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