Healthcare Provider Details

I. General information

NPI: 1003598210
Provider Name (Legal Business Name): SHACHAT DENTAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W VAN BUREN ST # F6
CHICAGO IL
60607-3909
US

IV. Provider business mailing address

212 W VAN BUREN ST # F6
CHICAGO IL
60607-3909
US

V. Phone/Fax

Practice location:
  • Phone: 312-441-0096
  • Fax: 773-943-7344
Mailing address:
  • Phone: 312-441-0096
  • Fax: 773-943-7344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW SHACHAT
Title or Position: FOUNDER
Credential: DMD
Phone: 312-441-0096