MEDICARE: DR. SAI RAMANI KRISHNA KUMAR

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	1223G0001X	General Practice Dentistry	019.030489	IL

General Provider Information

NPI Number	:	1255707170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAI RAMANI KRISHNA KUMAR

Provider Business Mailing Address
First Line	:	350 N CLARK ST FL 6
Second Line	:	DENTAL DREAMS LLC C/O DANIELLE THARP
City	:	CHICAGO
State	:	IL
Zip	:	60654-4712
Country	:	US
Telephone Number	:	312-274-4524
Fax Number	:

Provider Business Practice Location Address
First Line	:	2254 S CICERO AVE
Second Line	:	DENTAL DREAMS
City	:	CHICAGO
State	:	IL
Zip	:	60804-2411
Country	:	US
Telephone Number	:	708-656-2222
Fax Number	:

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

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	12/22/2015

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