MEDICARE: RESHMA 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	122300000X	Dentist	1002141	WI

General Provider Information

NPI Number	:	1457912552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RESHMA SHAH DMD

Provider Business Mailing Address
First Line	:	2050 E ALGONQUIN RD STE 610
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173-4166
Country	:	US
Telephone Number	:	888-988-4066
Fax Number	:	847-496-4850

Provider Business Practice Location Address
First Line	:	142 E CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1206
Country	:	US
Telephone Number	:	888-988-4066
Fax Number	:

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

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	06/28/2019

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