MEDICARE: ANKITA SHAH DMD

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	1223G0001X	General Practice Dentistry	019.027537	IL

General Provider Information

NPI Number	:	1306020656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANKITA SHAH DMD

Provider Business Mailing Address
First Line	:	1202 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1908
Country	:	US
Telephone Number	:	818-324-3315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1908
Country	:	US
Telephone Number	:	312-724-7161
Fax Number	:

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

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	03/16/2026

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