Provider Demographics
NPI:1730563263
Name:NARVEKAR, ANIRUDDH
Entity type:Individual
Prefix:
First Name:ANIRUDDH
Middle Name:
Last Name:NARVEKAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N STATE ST
Mailing Address - Street 2:APT 1908
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7231
Mailing Address - Country:US
Mailing Address - Phone:215-514-4338
Mailing Address - Fax:
Practice Address - Street 1:540 N STATE ST
Practice Address - Street 2:APT 1908
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-7231
Practice Address - Country:US
Practice Address - Phone:215-514-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190302461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics