MEDICARE: OAKTON PLACE DENTAL LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1891001574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKTON PLACE DENTAL LLC

Provider Business Mailing Address
First Line	:	1635 OAKTON PL
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018
Country	:	US
Telephone Number	:	847-803-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 OAKTON PL
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-2002
Country	:	US
Telephone Number	:	847-803-8800
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. AMI K SHAH
Credential	:	D.D.S
Telephone Number	:	847-361-2400

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	08/19/2010

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Directions to “OAKTON PLACE DENTAL LLC ” Practice Location

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