Healthcare Provider Details

I. General information

NPI: 1275061582
Provider Name (Legal Business Name): OBAID SHAH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 S PULASKI RD STE 102
CHICAGO IL
60632-4253
US

IV. Provider business mailing address

345 N MASTERS DR
ADDISON IL
60101-4117
US

V. Phone/Fax

Practice location:
  • Phone: 773-423-2810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.031828
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.026328
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: