Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019029639 | IL |
NPI | 1003151432 |
---|---|
Provider Name | Dr. Sneha Bakulesh Naik |
First Address | Chicago, IL 60605-3286 |
Second Address | Chicago, IL 60605-3286 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2012 |
Last Update Date | 12/02/2015 |