MEDICARE: SAIVI DENTAL PLLC

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	24942	TX

General Provider Information

NPI Number	:	1285005173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAIVI DENTAL PLLC

Provider Business Mailing Address
First Line	:	308 VINE ST
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2847
Country	:	US
Telephone Number	:	305-219-1668
Fax Number	:

Provider Business Practice Location Address
First Line	:	3654 N BELT LINE RD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-7805
Country	:	US
Telephone Number	:	214-307-4755
Fax Number	:

Authorized Official
Title or Position	:	OWNER/GENERAL DENTIST
Name	:	NAREN KUMAR MIKKILINENI
Credential	:	DMD
Telephone Number	:	305-219-1668

Provider Enumeration Date	:	10/17/2015
Last Update Date	:	10/19/2015

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