MEDICARE: KIM TAPIAWALA DDS

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	019.036498	IL
2	122300000X	Dentist	39696	TX

General Provider Information

NPI Number	:	1811696172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM TAPIAWALA DDS

Provider Business Mailing Address
First Line	:	4437 RIPTIDE LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-7045
Country	:	US
Telephone Number	:	469-243-7454
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5247
Country	:	US
Telephone Number	:	312-666-3494
Fax Number	:

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

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	12/19/2025

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