Healthcare Provider Details

I. General information

NPI: 1083007744
Provider Name (Legal Business Name): ZAINAH M SHAKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
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

5160 S PULASKI RD STE 102
CHICAGO IL
60632-4253
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 TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.034271
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD13530
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: