MEDICARE: PRIYANKA NAIRI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019031416	IL

General Provider Information

NPI Number	:	1104337666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYANKA NAIRI

Provider Business Mailing Address
First Line	:	676 N MICHIGAN AVE STE 3500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2839
Country	:	US
Telephone Number	:	312-274-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	676 N MICHIGAN AVE STE 3500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2839
Country	:	US
Telephone Number	:	312-274-3333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	12/23/2020

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Directions to “ PRIYANKA NAIRI ” Practice Location

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