Provider Demographics
NPI:1750416434
Name:SIVANANTHAN, INTHUMATHY (M)
Entity type:Individual
Prefix:DR
First Name:INTHUMATHY
Middle Name:
Last Name:SIVANANTHAN
Suffix:
Gender:F
Credentials:M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2783 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532
Mailing Address - Country:US
Mailing Address - Phone:630-857-3444
Mailing Address - Fax:630-857-3056
Practice Address - Street 1:2783 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532
Practice Address - Country:US
Practice Address - Phone:630-857-3444
Practice Address - Fax:630-857-3056
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190234131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice